Eligibility Specialist

Hiring Range:

Full Pay Range:

Job Summary:

*The eligible register developed from this posting may be used to fill future FT or PT or on-call vacancies within this classification

*We are filling 2 Full-time positions

ESSENTIAL DUTIES

• Determines eligibility through processing applications, renewals, and changes in circumstances for all programs in accordance with federal, state, and county policies and procedures.   
• Interprets, explains, and guides clients through complex and frequently changing policies for multiple programs; serves as a client resource and advocate.
• Reviews, analyzes, and interprets complex tax, financial, and legal documents as needed for specific program eligibility requirements; consults with the County Attorney's office as required. 
• Codes MMIS billing systems accurately and timely with enrollees’ eligibility, allowing for payments to health care providers.
• Coordinates, collaborates, and corresponds with internal and external providers to ensure clients have access to and are informed on all available services.  
• Maintains accurate client case records within the county's electronic document management system.
• Maintains current knowledge of multiple complex program policies for all programs and shares that knowledge with residents and program participants to keep them informed of their rights and responsibilities.  
• Enrolls participants in managed health care plans; determines cost effectiveness of employer-offered health insurance and reimburses eligible participants; serves as client advocate and investigates and resolves problems related to managed care.  
• Utilizes and navigates between multiple case and document management systems for access to benefit information; conducts manual eligibility determinations as needed.  
• Represents the county in appeal hearings in the presence of a Human Services judge where the appellant may be represented by an attorney. Prepares appeal summaries citing relevant policy and statute pertaining to the issue being appealed; takes appropriate and timely action based on appeals decision.  
• Operates within laws that govern Data Privacy and Freedom of Information.  
• Works the hours and/or shifts assigned and begins and ends work on time.  
• Performs other related duties as required or assigned.

MINIMUM QUALIFICATIONS

Must have one of the following:

High school diploma or GED and 4 years of related work experience in a position involving health and human services or working to determine program eligibility for public assistance benefits for a broad range of clientele. 

High school diploma or GED plus one year of post-secondary education and 2 years of related experience

Associate's Degree and 1 year of related experience

Bachelor's Degree

Education must be related to human services, business, or accounting. Recent public assistance eligibility experience and bilingual abilities strongly preferred. One must possess excellent interpersonal skills and be able to multi-task in an environment with changing priorities. The incumbent must have a reliable means of transportation for the performance of work responsibilities.

SUPERVISORY CONTROLS

With latitude for independent judgment, the employee is under general supervision of a Eligibility Supervisor. The employee follows established procedures and guidelines. Work is reviewed on a systematic basis by State Quality Control reviewers, a supervisor, or a trainer.

The incumbent may provide training and assistance to other employees.

CORE COMPETENCIES AND ABILITIES

• Customer Service - Delivers government services in a respectful, responsive, and solution-oriented manner.
• Communication - Is always clear about what we're doing and why we're doing it.
• Collaboration - Works with partners – communities, schools, faith groups, private business, and non-profit agencies – to see that services are not duplicated but rather are complimentary, aligned, and provided by the partners who can deliver the service most effectively.
• Stewardship - Works proactively to make investments, guided by resident input, which will transform lives, communities, and government.
• Empowerment - Works with individuals and families to affirm strengths, develop skills, restore hope, and promote self-reliance.
• Resiliency - Fosters public preparedness and responds when families and communities face health and safety emergencies.
• Innovation - Takes informed risks to deliver services more effectively and learns from successes and failures.
• Knowledge - Knowledge of statutory and regulatory requirements of federal, state, and county public assistance programs.
• Knowledge of agency programs, operations, policies and procedures, and available community resources.
• Demonstrates knowledge and understanding of human behavior, cultural diversities, and language barriers to ensure equitable service delivery.
• Knowledge of financial case management and interviewing techniques.
• Ability to analyze facts and methodically problem solve.
• Ability to provide assistance to others.
• Ability to effectively organize and coordinate work activities.
• Ability to establish and maintain effective working relationships with employees, clients, and the public.
• Ability to prepare reports and to accurately and rapidly process detailed information.
• Ability to establish and maintain accurate and systematic records.
• Ability to use MS Office software for the performance of essential duties.
• Ability to use appropriate discretion in dealing with matters of a confidential nature.

WORK ENVIRONMENT AND PHYSICAL DEMANDS

Typical characteristics of the regular, ongoing work environment of this position requires 40 hours of inside work, typically in an office setting. Some field work may be required. The position is multi-task oriented and includes periods of stress when balancing the needs/demands of multiple clients.

Physical activities include sedentary to light work: Reaching, sitting, standing, walking, pushing, lifting, pulling, fingering, grasping, feeling, talking, hearing, seeing, and repetitive motions. Lifts and/or navigates up to 35 pounds on a routine basis in handling files and equipment necessary for performing the essential duties of the job. 

SELECTION PROCESS

Selection for this position will be based on a minimum qualifications screening and rating of training and experience. Top candidates will be forwarded to hiring manager or supervisor for consideration for interview and/or additional assessments. Final selection will include a background check and approval by the County Board.

Work Location:

A comprehensive benefits package is provided for all employees who work 20 hours per week or more. For detailed benefit information visit the Scott County Benefit Hub using this LINK