Eligibility Specialist

Eligibility Specialist – 066-09-21

Job Tracking ID: 512378-791266

Job Location: McMinnville, OR

Job Level: Mid Career (2+ years)

Level of Education: Any

Job Type: Full-Time/Regular

Date Updated: October 04, 2021

Years of Experience: 2 – 5 Years

Starting Date: ASAP

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Job Description:
This position requires someone who can gather information AND likes working with numbers, policies and people to determine eligibility for social service programs.

We look for individuals in our organization who are passionate about our mission and values, and providing excellent customer service.

We value our employees, working closely with them to help them be successful. We value the people we provide services to, ensuring they receive the highest quality of customer service.

Recruitment #: 066-09-21

Closes: October 18, 2021

Location McMinnville

Salary: Starting at $3,682 with excellent benefits (see below)

Agency Sponsored: Medical/Dental 100% paid for employee and 90-98% for dependents, generous Paid-time off, Public Employee Retirement (PERS), Employee Assistance Plan, Long Term Disability, great culture.

Employee paid: Deferred Compensation, Life Insurance, Short Term Disability, Colonial Life Supplemental Plans, Legal Shield.

PURPOSE OF JOB

Meets Agency Mission, Vision and Values by determining financial eligibility for benefits and enrolling consumers, and ongoing maintaining of consumer enrollment in various medical assistance programs.

NOTE: Eligibility Specialist positions may focus on specific outcomes and focus on carrying a specific workload, such as specializing in intakes, recertifications, or a combination of all noted outcomes. Specialization may be subject to change.

Essential Functions

1. Determine eligibility for participation in financial, medical, and SNAP benefits

2. Conduct annual reviews of financial eligibility for participation in financial, medical and SNAP benefit programs

3. Provides ongoing consumer maintenance

4. Provides additional assistance to consumers as needed

5. Promotes person centered services

6. Protects consumers and reduces Agency risk

7. Provides excellent service in a professional manner

1. Determine eligibility for participation in financial, medical and SNAP benefit programs by:

Interview individuals via phone or in person to gather necessary information.

Explain benefits and resources available.

Review application document for completeness (may include helping individual through application process).

Assist applicant in obtaining verifications.

Collaborate and coordinate with others including Department of Human Services, Oregon Health Authority, Coordinated Care Organizations, attorneys, behavioral health partners, pharmacies, Social Security Administration, Medicare, medical providers, etc.

Process forms and documents.

Apply program rules and policy to determine if individual qualifies for programs.

Provide notification of eligibility decisions timely and completely as outlined in rules and policy.

Maintain electronic and paper consumer files.

Cover incoming calls on eligibility for unit, i.e. “Worker of the Day.”

2. Conduct annual reviews of financial eligibility for participation in financial, medical and SNAP benefit programs

Ensure consumer receives re-determination information.

Review returned materials for completeness.

Contact consumer for additional information or to clarify as necessary.

Apply program rules and policy to determine if individual continues to qualify for program.

Provide notification of eligibility decisions timely and completely as outlined in rules and policy.

Maintain electronic and paper consumer files.

Process information, forms and documents between determinations to ensure consumer benefits are current.

3. Provide ongoing consumer maintenance

Receive, review and process updated information from consumers.

Adjust benefits as needed.

Verify information.

4. Provide additional assistance to consumers as needed

Process and review forms and data related to MMIS database.

Provide addition resources and community referrals as appropriate.

Attend consumer hearings and providing testimony as necessary.

Process other reports as necessary, such as reporting deceased consumers, monthly reports to manager on closed, denied and withdrawn cases.

(FOR BILINGUAL POSITIONS ONLY)

Ensure Non-English speaking consumers receive services

Communicate with individuals whose primary language skills are non-English.

Provide services to consumers whose primary language skills are non-English.

Serve as an interpreter for the Agency in identified language pair, including oral and written, interpret and explain forms, explain rules and policies, etc.

Translation of written materials.

5. Promote person centered services

Embrace and exhibit the Agency Mission and Core Values.

Understand the role of consumer choice.

Interact with the public, consumers, co-workers and others in a patient, respectful and culturally appropriate manner.

Educate self and others of resources available for populations served, including researching electronic and written materials and Aging and Disability Resource Connection of Oregon resource database.

Understand other Agency resources and accessing resources and assistance to consumers as needed

6. Protects consumers and reduces Agency risk

Follow policies, regulations and requirements of project and Agency; document plan and progress as required.

Serve as a Mandatory Reporter of suspected abuse of vulnerable populations as required by policy and regulation.

Maintain and sharing information according to privacy regulations.

7. Provides excellent service in a professional manner

Meet the needs of consumers, follow through, meeting deadlines, and maintain skills and knowledge to perform the job.

Apply the required knowledge and skills and exhibit critical thinking and problem solving.

Exhibit good decision making, problem solving and work habits.

Meet quality standards in accuracy, judgment, timeliness and following policy and procedure.

Exhibit good work habits, including organizational skills, regular attendance, working independently, seeking and offering assistance when needed.

Exhibit technology skills related to the work needing to be done, (word processing, spreadsheets, database, internet research, mail, IM, phones, copiers, assessment programs like as CAPS, Oregon ACCESS, etc.);

Regular attendance to meet the demands of this job and provide necessary services.

Experience and Skills:
QUALIFICATIONS

We will consider any combination of education and experience that shows the minimum knowledge, skills and abilities to perform the job. A typical way to obtain this combination would be:

Associates degree in social sciences, business administration or other related studies;

Two years of responsible social service or business experience involving interviewing to obtain information of a personal and technical nature.

Ability to secure and maintain a driver’s license valid in the state of Oregon, or an acceptable alternative means of transportation. Successful completion of a background check.

(FOR BILINGUAL POSITIONS ONLY)

Successful completion of a Language Proficiency Test

Knowledge, Skills, and Abilities

The successful applicant must have the following general skills, including the ability to:

Understand and interpret applicable policies and apply them to problem-solving and decision-making in order to serve external and internal customers

Apply the knowledge and skills in a timely, accurate, and efficient manner to meet deadlines

Process a high volume of work with critical deadlines

Organize and prioritize work to meet required time timeframes

Multi-task

Collaborate and coordinate with others

Build relationships and network

Exhibit excellent interpersonal communication and listening skills

Exhibit good judgment, and use courtesy and tact

Speak, read, write, and understand English

Follow verbal and written instruction

Know and commit to abide by rules governing consumer confidentiality and mandatory reporting

The successful applicant must have the following job-specific skills, including the ability to:

Learn available services of Agency and other community services

Apply knowledge of program rules

Utilize general math skills

Interview and obtain general and financial information

Understand the role of the individual’s preferences in care success

Keep up with fast changing rules through training and resources provided by the Agency

Learn and use database to maintain complete and timely files, including data entry and narration of ongoing work

Meet quality work standards

Learn and apply general office practices such as confidentiality rules, employee records maintenance, client records maintenance, and agency policies and procedures applicable to the specific program and area of work

Use extensive business-English skills (grammar, spelling, and punctuation)

Operate a personal computer, copier, fax machine, phone, and general office equipment, etc.

(For Bilingual) Successfully demonstrate the required level of oral and written proficiency for bilingual duties in identified language pair (English/Spanish, Russian, ASL, etc.)

Other Requirements

The successful applicant must have the following skills, including the ability to:

Support the agency’s mission, ethics, and values

Secure and maintain a valid driver’s license in the state of Oregon, or an acceptable alternative means of transportation

Commit to regular attendance as it is required to meet the demands of this job

Pass a criminal background check successfully

Maintain and share information according to privacy regulations

Serve as a mandatory reporter of suspected abuse of vulnerable populations as required by policy and regulation

Complete necessary work as assigned

WORK ENVIRONMENT/PHYSICAL DEMANDS

This is a fast-paced, deadline-driven position where accuracy, efficiency and excellent customer services are essential. Frequent consumer contact, high volume detailed work.

This job is performed primarily in the office with possible occasional work in the field.

Office work will be conducted using general office equipment, includes substantial sitting and is performed primarily in a cubicle environment, with noise and interruptions, being on phones and working at a computer. Field work requires travel to clients in a variety of settings, homes, facilities, etc. of varying level of cleanliness and repair. Field work requires driving an Agency car or employee car, carrying and using a laptop computer.

These essential outcomes require regular sitting, talking, hearing, computer use; frequently required to use repetitive hand motion, handle or feel, and to stand, walk, reach, bend or lift up to 25 pounds.

Contact with the public in home or office environments may risk exposure to irrational/hostile behavior, contagious diseases, or contact with domestic animals.

Reasonable accommodation may be made to enable individuals with disabilities to perform the essential functions.

Classification: Eligibility Specialist

Bilingual Eligibility Specialist

Position Number: varies

Salary Range: R19/R20 for bilingual

FLSA Status: Non-Exempt

Unit: Varies

Location: Varies

Reports to: Services Manager

Union Status: Represented

Last revision: May 2016

This job description is a general guide for the job to be performed and does not cover everything. Employees may be required to perform other duties, including covering for, and in, other offices. Employees are expected to follow and perform other job-related duties requested by their manager.

Reasonable accommodations will be made as needed.

Job descriptions are subject to change.