Eligibility Determination Worker

TX-HHSC-DSHS-DFPS • Austin, TX

1d • Onsite

About The Position

Performs routine consultative services and technical work to assist in the planning, development, implementation, and coordination of the daily operations and special projects of the Texas HIV Medication Program (THMP). Evaluates and applies operational processes based on program policies and procedures to determine eligibility for THMP clients. Trains other staff, governmental agencies, HIV service agencies, and the public on program eligibility criteria and application processing procedures. Provides consultative and technical services to agency program staff, other governmental agencies, community/professional organizations, and the public to help coordinate and improve client access to the program and to promote client adherence to physician-prescribed medication regimens. Contributes to the development of program literature and educational material. Develops, implements, and maintains data collection and analysis programs using available software applications. Assists the Program Manager with planning, assigning, and evaluating work duties performed by others. Work is performed under the supervision of the Program Manager with moderate supervision and limited latitude for the use of initiative and independent judgment.

Requirements

• Knowledge of current social, economic, and public health issues related to HIV/AIDS; public health laws and regulations; educational techniques and procedures; and medical terminology and medications commonly used in the treatment of HIV/AIDS and STDs.
• Skill in performing applicant eligibility determination using identified screening criteria; in composing, organizing, proofreading, and editing requisitions, reports, and correspondence for accuracy and clarity; in instructing others; and in using personal computers for data entry, running reports, and developing correspondence using Excel and Word.
• Ability to train others; interpret Public health laws and regulations; analyze and assess public health needs; perform data entry with speed and accuracy; effectively communicate verbally and in writing; develop, implement, and evaluate policies and procedures; to understand and adhere to applicable laws and rules regarding confidential information; to plan, organize and coordinate multiple projects while meeting strict deadlines under minimal supervision; to handle and process materials that are highly time-sensitive and that require rapid processing; and to verify client eligibility using third-party verification processes.
• Graduation from an accredited four-year college or university with major course work in social work, public health, or health care administration.
• Experience and education may be substituted for one another. Two years of directly related experience can substitute for one year of college.
• Examples of experience include eligibility determination, processing applications, verifying information, maintaining digital records, communicating with clients and external stakeholders, and interpreting guidelines.
• Must be legally authorized to work in the U.S. without sponsorship.

Nice To Haves

• Experience with AIDS Drug Assistance Program (ADAP), State Pharmacy Assistance Program (SPAP), and other special or pilot programs administered by the THMP.
• Experience with Ryan White payer of last resort requirements.

Responsibilities

• Provides support to the Regional Coordinator and collaborates with other program staff to develop eligibility guidelines and screening processes (including applications, forms, and instructions).
• Assists in ensuring eligibility guidelines and screening processes maintain compliance with Ryan White payer of last resort requirements, and coordinates client needs with other available community resources and services.
• Assists in reviewing policies related to the assigned region at least annually and preparing justifications for changes identified as necessary.
• Assists with eligibility determinations for new, recertification, and self-attestation applications for medication assistance through the Texas HIV Medication Program in the assigned region.
• Reviews proof of HIV positivity, financial eligibility, Texas residency, and insurance status, including both documentation provided by the applicant and verification information provided with the application, to determine if the application is approved or incomplete.
• Assists in determining eligibility denials for applicants who do not meet program criteria by providing an initial determination.
• Composes a letter of determination to the applicant and the Community ADAP Enrollment Worker who assisted with the application, with the letter of denial, approval, or incomplete application.
• Inputs all eligibility information into the THMP database, including updating demographic information previously entered into the system, noting documentation and relevant details of how eligibility determination was made, and selecting the type of eligibility determination.
• Compiles and evaluates statistical data used to develop THMP eligibility projections.
• Provides weekly statistical information to the THMP Manager, including productivity counts and quality improvement review data.
• Assists with preparing administrative reports for THMP's Advisory Committee.
• Reviews and prepares research findings relative to project development.
• Develops, implements, and maintains data collection and analysis programs using available software applications.
• Assists in the THMP Quality Management Committee and quality management activities.
• Assists in program planning, development, implementation, and evaluation.
• Serves as a liaison with local ADAP Enrollment Workers who assist with application completion in the region, assisting with explaining the application process and requirements of the THMP.
• Performs THMP outreach efforts, assisting in planning and delivering training and workshops specific to the eligibility process for the assigned region.
• Assists with cross-training THMP staff.
• Marginal function - relevant and timely projects as assigned by the Program Manager.
• Other duties as assigned include, but are not limited to, actively participating and/or serving in a supporting role to meet the agency’s obligations for disaster response and/or recovery or Continuity of Operations (COOP) activation.

Benefits

• Insurance coverage and other benefits available through the State of Texas Group Benefits Plan administered by the Employee Retirement System of Texas (ERS).

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Number of Employees: 1-10 employees