Position Details

Eligibility Specialist

Job Number: 162

Location: Odessa

Supervises: N

FLSA: Non-Exempt

Division: MH

Salary:  $15.66 per hour.  Sign on bonus may be available.

Shift: M-F 8am ? 5pm; Assigned work hours may change as the needs of the agency and clients change

Driving required: Y

Travel required: Y

Settings: office, field

POSITION SUMMARY/JOB PURPOSE:

The Eligibility Specialist assists potential and current clients with mental illness or intellectual and developmental disabilities in obtaining and/or maintaining Medicaid eligibility.  This position reviews benefit screening forms and makes decisions regarding potential eligibility for state programs.  The Eligibility Specialist serves as the primary contact with designated liaisons from Social Security Disability Determination Services.

This position works independently, under limited supervision, reporting major activities through periodic meetings.

EDUCATION, EXPERIENCE, OTHER QUALIFICATIONS:

Education Required:  High School Diploma or GED.

Experience Required:  At least 1 year of general office experience.

Registration, Certification, Licensure or other Qualifications Required: 

  • Must maintain a valid Texas Driver's license, auto liability insurance and a driving record acceptable to PermiaCare's insurance requirements.
  • Required to pass criminal history and background checks as well as pre-employment drug screen.
  • Must receive Benefits Eligibility Certification within 6 months of employment.

ESSENTIAL DUTIES AND RESPONSIBILITIES:

  • Review benefit screening forms and make decision regarding possible eligibility of potential and current PermiaCare clients. 
  • Notify staff and clients of appointments with outside agencies and of appointment changes.
  • Serve as primary contact with designated liaisons from Disability Determination Services.
  • Ensure the information gathered and entered on the benefit application is accurate and the supporting documentation submitted with the application is applicable to the individual's case to satisfy the required elements required by the state, possibly securing a prompt allowance/response.
  • Responsible for all activities in assisting potential or current PermiaCare clients to obtain Medicaid eligibility, gather information for the SSI/Medicaid application, provide guidance in completing Medicaid eligibility applications and advocating on their behalf during the Medicaid appeals process.
  • Provide thorough research and verification.
  • Maintain accurate records.
  • Process applications and documents in accordance with laws, regulations and organizational processes.
  • Provide guidance and assistance to applicants on the process of applying for services and benefits.
  • Respond to inquiries and requests for information promptly.
  • Stay abreast of changes in regulations, policies, and procedures governing eligibility.
  • Meet unit performance measures or targets.
  • Maintain assigned caseload of individuals.
  • Coordinate appropriate services to designated caseload.
  • Enter accurate and appropriate documentation of services within timeframe required.
  • Maintain confidentiality of sensitive records and treatment information, client files and protected health information in compliance with HIPAA, laws, rules and regulations, and established procedures.
  • Maintain regular and reliable physical on-site attendance. Regular attendance, dependability, and promptness are required for the scheduled work day 100% of the time, to ensure consistency and completeness of program's processes.
  • Comply with the Abuse, Neglect, and Exploitation policy and reporting requirements.
  • Adhere to the Code of Conduct and Standards of Behavior policy requirements.
  • Establish and maintain effective work relationships with individuals served and their families, supervisors, co-workers and visitors by demonstrating cooperative, courteous and respectful behavior at all times.
  • Communicate regularly with supervisor.
  • Open and process mail/email in a timely manner.
  • Answer phone, collect phone messages and respond to requests timely and accurately.
  • Maintain safe and clean working environment by complying with procedures, rules and regulations.
  • Perform all work functions and interactions using a trauma informed approach.
  • Display professionalism when representing PermiaCare and the program in the community.
  • Maintain compliance with legal requirements and company policies and procedures.
  • Maintain valid and current driver's license, auto insurance, acceptable driving record and reliable transportation at all times. Driving may be required for this position.
  • Complete all training as assigned prior to due date.
  • Other duties as assigned.

MARGINAL DUTIES AND RESPONSIBILITIES (these duties are not designated as essential for the purposes of ADA; they are still required duties):

  • Fill in for other Eligibility or Financial staff as needed.
  • Serve as a resource for other programs.
  • Train staff on benefits eligibility design and processes as needed.
  • Attend the Consumer Benefits Organization (CBO) consortia at least once every other year to stay up-to-date on the Benefits and Work Incentives Planning Supports and Services for rehabilitation services.
  • Provide translation, if applicable.
  • Participate in team meeting or staffings.
  • Participate in community activities and/or attends community meetings as needed.
  • Participate in workgroups and committees as assigned.

KNOWLEDGE, SKILLS, ABILITIES AND COMPETENCIES:

  • Knowledge of office practices and procedures.
  • Knowledge of state and federal benefits, such as Medicaid and Social Security Disability services.
  • Knowledge of government health plans.
  • Understanding of ACA and how it affects eligibility determinations.
  • Ability to maintain accurate records.
  • Ability to use eligibility verification systems and databases.
  • Knowledge of HIPAA and ability to protect confidentiality.
  • Effective multi-tasking skills.
  • Good organizational skills.
  • Welcoming, positive behavior.
  • Ability to express self clearly and effectively, orally and in writing.
  • Effective time management skills.
  • Exceptional customer service skills, including positive attitude.
  • Cultural sensitivity.
  • Dependable attendance and punctuality.
  • Knowledge of trauma informed theories, principles and practices.
  • Flexibility and adaptability to different work environments.
  • Excellent computer skills, including Word, Excel, Outlook, and Electronic Health Records (EHR).
  • Reading and comprehending.
  • Reasoning and analyzing.
  • Ability to coordinate with various inter-agency personnel.
  • Ability to fulfill PMAB and CPR/First Aid requirements.
  • Ability to work independently.
  • Good interpersonal skills, including ability to build rapport with individuals including co-workers.
  • Ability to display comfort in interacting with individuals of diverse cultural, ethnic and economic backgrounds and with social service, healthcare, educational and criminal justice organizations, as needed.
  • Ability to acquire and utilize new skills as the job requires.
  • Ability to work cooperatively and productively with supervisor, individuals, co-workers, and groups of persons at all levels of activity, contributing to a spirit of teamwork.
  • Ability to maintain highly confidential information.
  • Ability to remain calm in stressful situations.
  • Ability to plan and schedule work and implement directives without constant supervision.
  • Model professionalism by appropriate dress, language, ethics and work habits.
  • Ability to drive personal and/or company vehicle.  This position may require travel to agency program sites, community and residential sites, and/or locations outside the PermiaCare catchment area.  This position may require transport of agency individuals and/or individuals served.

PHYSICAL REQUIREMENTS:

Abilities Required:

  • Light Lifting, under 15 lbs
  • Light Carrying, under 15 lbs
  • Walking
  • Standing
  • Sitting
  • Operating office equipment
  • Operating motor vehicle
  • Ability to see
  • Identify colors
  • Depth perception needed
  • Hearing (with aid)
  • Hearing (without aid)
  • Ability to write
  • Ability to count
  • Ability to read
  • Ability to tell time

Other (specify):  driving required. May require some travel after hours and overnight.

WORKSITE CONDITIONS:

  • Travel
  • Inside
  • Working closely with others
  • Working alone

ADA Statement:  Reasonable accommodations may be made to enable individuals with disabilities to perform essential functions.

EEO Statement:  PermiaCare is committed to hiring and retaining a diverse workforce. We are proud to be an Equal Opportunity Employer, making decisions without regard to race, color, ethnicity, national origin, sex, sexual orientation, gender identity, religion, age, disability, veteran status, genetic information, or any other characteristic protected by state or federal law.

This job description is not designed to cover or contain a comprehensive list of duties, activities or responsibilities that are required of the employee for this job.  Duties, activities and responsibilities may change or new ones may be assigned at any time with or without notice. This job description does not constitute an employment contract with PermiaCare.  Employment is at-will. 

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