Eligibility Advisor IV

TX-HHSC-DSHS-DFPS•Weslaco, TX

2d•Onsite

About The Position

The Texas Health and Human Services Commission (HHSC) seeks highly qualified candidates to fill the Eligibility Advisor IV position within the Office of Medical and Social Services (MSS), Access and Eligibility Services (AES) Integrity Support Services (ISS). The MSS is driven by its mission to connect people, services, and supports by helping individuals and families in need of food, medical care, cash assistance and other social services. The ideal candidate will thrive in an environment that emphasizes: innovation through new ideas, striving for excellence by taking pride in your work, embracing our differences as a source of strength, accomplishing more through partnership, leading by example, and learning for continuous improvement. The Texas Health and Human Services (HHS) seek highly qualified candidates to fill the Eligibility Advisor IV within the Access & Eligibility Services (AES) Department Eligibility Operations Integrity Support Services (ISS). AES is driven by the mission to connect Texans to services by helping individuals and families in need of food, medical care, cash assistance, and other social services. Functions as an analyst that performs (senior-level) eligibility determination reviews for social service programs. Reviews and analyzes cases to prevent potential fraud prior to certification. Under the direction of management, reviews cases for compliance of public assistance laws and regulations. Applies regulations and procedures to determine accurate eligibility for public assistance programs. The Eligibility Advisor IV evaluates, summarizes, documents findings, and prepares detailed case reports. Collects information and prepares records for referral to analysts to conduct hearings and appeals and responds to client complaints. Reviews suspected fraud cases; identifies and contacts potential witnesses and clients. Makes collateral calls to verify recipient case information. Reviews and analyzes documents and reports from multiple agency, state, and federal databases to collect data and to determine, or verify, new and continued program eligibility. Assists with development and delivery of training presentations to HHS staff. Work involves coordinating the review of eligibility cases, verifying information with clients, collateral sources, residential facilities and employers. Verifies case data and resolves problems and complaints. Works under limited supervision, with considerable latitude for the use of initiative and independent judgment. Monitor, reviews, and communicates case status and changes to clients and/ or authorized representatives. Communicates all case changes and provides status updates to the management team and/or Director of the Eligibility Operations-Integrity Support Services (ISS).

Requirements

High School diploma or GED equivalent is required.
Sixty (60) semester hours from an accredited college or university is required OR two years of experience may be substituted for education.
Two years’ experience determining eligibility for SNAP, Medicaid, or TANF within the last four years.
Experience which indicates skill in data review and analysis required.
Experience working in a professional customer service environment required.
Experience which demonstrates skill in communicating verbally and in writing required.
Application indicates willingness to work beyond normal work hours of 8AM-5PM as needed/required.
Application indicates the willingness to travel 20% of the time required.

Nice To Haves

Degree from an accredited college or university is preferred.
Experience conducting fraud analysis related to human services programs preferred.
Experience evaluating eligibility cases for accuracy and fraud detection preferred.
Training or experience in fact-finding principles preferred.

Responsibilities

Reviews suspected fraud cases and makes referrals to Office of Inspector General investigators as needed.
Reviews case records to determine validity and accuracy of eligibility determinations made by other staff.
Conducts effective reviews and obtains information by observing and recording examinations.
Performs fact-finding client interviews.
Analyzes and evaluates the client’s statements.
Interprets, understands, and applies provisions of public assistance laws.
Prepares clear and concise written and oral reports while dealing effectively with the public and departmental staff.
Documents case files using automated equipment to form a case record for each client.
Initiates, monitors, and manages service improvement projects and reports on activities.
Analyzes situations accurately and adopts an effective course of action to resolve discrepancies.
Responsible for explaining program benefits and requirements to clients and/or advisor staff as necessary.
Resolves problems and complaints.
Presents findings and provides status updates to the management team and/or Director of the ISS.
Assists in the oversight and development of eligibility functions which includes recommendations for development of training, operational policies and procedures.
Monitors completion of referred precertification cases by field Advisors.
Provides quality improvement opportunities to the Eligibility Operations-Field Operations (EO-Field Ops) to ensure eligibility determination and benefit issuance are timely and accurate according to state and federal regulations.
Assists in the oversight, review and evaluation of information regionally as it relates to service delivery systems.
Evaluates output activities and findings in order to identify gaps in resources, improvements or trends that impact business flow, agency goals, objectives, and the overall strategic plan for the program area.
Provides consultative services and technical assistance to plan, implement and monitor effective programs and services.
Provides information and may serve as a liaison with local, state, and federal agencies for the prevention and suppression of fraudulent benefit activities.
Compiles data, conducts analysis, prepares correspondence, and reports on the validity and accuracy of eligibility determinations.
Attends meetings, trainings, and workshops related to program benefits, requirements, rights to appeal and fair hearings to clients.
Compiles information to be used in bulletins, articles, and publications for the benefit of eligibility determination staff and/or clients and their authorized representatives.
Assists in the oversight of the preparation and development of legislative initiatives, analysis, and other complex documents that support the agency and the determination of eligibility for EO services and programs.
Prepares responses for request for information within EO.
May initiate and monitor special projects.