Title: Eligibility Specialist
Position Classification: Eligibility Specialist
Department: Senior and Disability Services Division
Reports to: Senior and Disability Services Program Supervisor
SUMMARY OF POSITION
This position is FLSA non-exempt and eligible for overtime. This position is union represented. Performs specialized financial eligibility functions including in-person, phone, or community interviews and collection/verification of financial information to make eligibility determinations and complete ongoing financial reviews. Access various state and federal database systems to collect/report data and issue state and federal benefits. This position is a Mandatory Reporter by statutory requirement.
Performs position duties in a manner that promotes customer service and harmonious working relationships, including treating all persons with compassion and respect. Collaboratively engages in effective team participation through willingness to assist and support co-workers, supervisors, and other work-related associations. Develops supportive working relationships with agency staff, supervisors, and community partners through active participation in shared workloads. Demonstrates ability to problem-solve and think critically by using complex policy to make informed decisions regarding eligibility for publicly funded programs. Demonstrates positive acceptance of constructive feedback and suggestions to strengthen work performance. Contributes to a positive, respectful, and productive work atmosphere committed to promoting diversity, equity, and inclusion. Regular attendance is required to meet the demands of this job and to provide necessary services. Teleworking option may be available following probationary trial service.
ESSENTIAL JOB DUTIES
75% Essential Duty 1: Determines financial eligibility for Medicaid, SNAP, TANF, ERDC, and other programs.
- Determines initial eligibility for Medicaid (Oregon Health Plan and Medicare Savings Plans), SNAP, TANF, ERDC, and other programs for applicants.
- Works in coordination with case managers to establish financial eligibility for individuals applying for or receiving long term support and services.
- Collects, reviews, and processes financial documentation and other supporting data associated with financial eligibility process within rule mandated timeframes.
- Performs ongoing financial eligibility functions and routine financial renewals of Medicaid, SNAP, TANF, ERDC, and other programs.
15% Essential Duty 2: Customer Service and Counselling on Benefits
- Engages with Oregonians via phone, email, in-person in the office, or in the community.
- Uses person-centered, trauma-informed communication skills.
- Counsels on basic Medicaid information including Coordinated Care Organization, income and resource standards, and other eligibility factors.
- Counsels Oregonians regarding the Medicare Modernization Act and facilitates enrollment in Medicare Advantage Plans and Medicare Prescription Plans
10% Essential Duty 3: Administrative Processes
- Refers Overpayments to Overpayment Writers
- Assists clients with Voter Registration
- Prepares and participates in audits of cases.
- Participates with the Hearing Officer on related hearings.
OTHER JOB DUTIES
- Identifies and makes referrals for applicants who may need additional support and services including being a mandatory reporter of allegations of abuse or neglect.
- Provides backup support as needed.
- Attends unit meetings, staffing, and trainings as directed by leadership team.
SUPERVISION RECEIVED: Receives general supervision from Senior and Disability Services Program Supervisor(s).
SUPERVISORY RESPONSIBILITIES: None
WORKING ENVIRONMENT
Work is performed primarily in an office environment utilizing an agency provided computer, telephone and a variety of office equipment. Position requires sitting for long periods of time and performing extensive telephone and computer work. Occasional travel to various meetings and training courses or appointments with Oregonians is also required.
MINIMUM QUALIFICATIONS
Experience & Training
Graduation from a four-year college or university with major course work in social services preferred and/or any satisfactory equivalent combination of education, training and experience which demonstrates the knowledge, skills, and abilities to perform the duties of the job.
Knowledge, Skills and Abilities
- Knowledge of functions and scope of public and private agencies and institutions providing social support services to vulnerable populations
- Knowledge and familiarity with problems and issues confronting low-income households in the local community.
- Knowledge of confidentiality rules regarding client and provider records, including HIPAA regulations
- Knowledge and ability to perform basic computer operations.
- Knowledge of and experience in Microsoft software
- Ability to effectively communicate both orally and in writing.
- Ability to effectively interview applicants to determine program eligibility.
- Ability to work effectively with applicants using good judgment in troubleshooting case issues/errors.
- Ability to interact with a culturally diverse population.
- Ability to interact and work effectively with representatives of other social agencies and members of the public.
- Ability to interact sensitively with older adults and/or persons with disabilities.
- Ability to exercise good time management skills in order to accomplish both daily and on-going tasks.
- Ability to work independently and prioritize multiple tasks and a high volume of work.
- Ability to compute and process required documents and recognize mathematical errors.
- Ability to research, interpret and implement Oregon Administrative Rules, Social Security rules and other state and federal rules, regulations, and policies.
- Ability to assess and diffuse emotionally charged situations in person or over telephone.
Licenses, Certificates, & Other Requirements
Possession of a Valid Oregon driver’s license or ability to obtain reliable transportation in order to travel as assigned.
Position requires successful completion of a criminal history and driving record check.
This job description in no way states or implies that these are the only duties to be performed by an employee occupying this position. Employees are required to follow any other job-related instructions and to perform any other job-related duties requested by their supervisor(s).
Requirements are representative of minimum levels of knowledge, skills and abilities. To perform this job successfully the employee will possess the abilities or aptitudes to perform each duty proficiently.