Eligibility Specialist Senior (Special Populations)

Overview

Under general direction, assists Eligibility Supervisor or Manager in a lead capacity in providing daily oversight and coordination for MAP mail-in, electronic application processing and performance improvement activities. Responsible for new employee and electronic application training and assisting in the application of performance standards, resolving complex customer problems and complaints, answering staff questions and interpreting and enforcing policy and procedure, and providing input into employee performance appraisals.

This position is considered Hybrid, which means that individuals in this position may work both at an approved Offsite location and Onsite at a primary location or multiple locations based on Business Needs.

Responsibilities

Essential Duties (at least 5 that are non-negotiable duties and are absolutely pertinent to successfully completing the job without accommodations):

• Leads work group activities as directed by program supervisor including providing daily oversight and coordination for assigned eligibility work sites, applying performance standards, training, answering staff questions and interpreting and enforcing policy and procedure, and providing input into employee performance appraisals.• Develop tools utilized to conduct audits on activities performed by Eligibility Services staff or outside contractor.• Analyzes the outcome of audits and complies reports on audit results including common trends.• Assists in training of new eligibility staff utilizing new staff training outlines and materials.• Makes decisions regarding a client’s eligibility for healthcare services including interpreting and applying complex program requirements explaining in both English and another foreign language program benefits and how to access services.• Assists customers in both English or another language in which you are fluent in resolving complicated problems and complaints regarding services.• May monitor changes to program guidelines and requirements, identify and coordinate implementation of changes as directed by program manager including the use of automated tools and plan, create, implement and maintain training programs as required.• Coordinates and oversees MAP mail-in and electronic application processing to include making work assignments to staff and following-up to ensure applications are processed as per deadlines, resolving problems, answering staff questions and interpreting and enforcing policy and procedure.• Provide oversight for the various audits of activities performed by Eligibility Services staff including site, file, interview and outcome audits as well as occasional audits of contractors.• Performs over duties as assigned

Knowledge/Skills/Abilities:

Knowledge of:• Administrative and clerical procedures and systems such as word processing and data base systems, filing and records management systems, transcription, and other office procedures and terminology• On-the-job training techniques and adult education methods.• Techniques used in change and culture management

Skill in:Ability to:• Communicating effectively in writing and speaking as indicated by the needs of the audience• Identifying the nature of problems, implementing solutions, observing and evaluating the outcomes of a problem solution to identify lessons learned or redirect efforts• Determining what is causing an operating error and deciding what to do about it• Determining what needs to be recorded and accurately and completely recording information to meet all policy, procedure and regulatory requirements• Knowing how to find information and identifying essential information• Using relevant information and individual judgment to determine whether events or processes comply with laws, regulations, or standards• Analyzing information and evaluating results to choose the best solution and resolve problems• Communicating effectively in speaking and writing as indicated by the needs of the audience• Coordinating activities by adjusting actions in relation to others’ actions• Fluently communicating verbally in English/Spanish• Being aware of others’ reactions and understanding why they react the way they do• Performing complex operations in Microsoft Office Suite• Listening to what other people are saying and asking questions as appropriate• Actively looking for ways to help people and establishing and maintaining effective working relationships• Scheduling people to meet the responsibilities of the work unit• Motivating people to achieve goals• Teaching others how to do something ad assessing how well one is doing when learning or doing something• Selecting and using training/instructional methods and procedures appropriate for the situation when learning or teaching new things.• Efficiently shift back and forth between two or more activities or sources of information• Correctly follow a given rule or set of rules in order to arrange things or actions in a certain order including procedures, orders or logical operations• Use deductive reasoning to apply general rules to specific problems to come up with logical answers and decide if an answer makes sense• Add, subtract, multiply or divide quickly and correctly and to understand and organize a problem and then to select a mathematical method or formula to solve the problem• Pay attention to details• Work effectively with individuals from diverse backgrounds• Read and understand basic foreign language on documents and forms• See details of objects at a close range (within a few feet of the observer)• Make fast, simple, repeated movements of the fingers, hands, and wrists

Physical Abilities:• While performing the duties of this job, the employee constantly is required to: Grasp, handle, feel, see, sit, listen, and talk.• The employee frequently is required to: Reach, drive a vehicle, teaching others how to do something and assessing how well one is doing when leaning or doing something, utilize a personal computer and commonly used software, e.g. Word, Excel and PowerPoint, to enter, retrieve, and communicate data.• The employee occasionally is required to: Lift up to 10 pounds

Qualifications

MINIMUM EDUCATION: Sixty (60) semester hours from an accredited college MINIMUM EXPERIENCE: • a minimum of four years related experience and verbal fluency in English and one or more foreign languages and some basic reading comprehension in both languages.• Any equivalent combination of education and experience may substitute.