Eligibility Specialist III (Medicaid)

Forsyth County (NC)•Winston Salem, NC

29d•Onsite

About The Position

The Department of Social Services is seeking a highly motivated, dependable professional with advanced communication skills and exceptional customer service abilities to determine eligibility for a variety of North Carolina Medicaid programs. The successful candidate must be able to interpret complex county, state, and federal policies and regulations, and use sound judgment to make accurate eligibility determinations. Strong organizational skills, the ability to perform basic mathematical calculations, and the capacity to work efficiently under strict deadlines are essential. Candidates must also possess knowledge of general office equipment and universal computer technology and be able to thrive in a team-oriented environment. This position serves as a Senior Eligibility Specialist (Eligibility Specialist III) for the Long-Term Care (LTC), Community Alternatives Program for Disabled Adults (CAP), and/or the Program of All-Inclusive Care for the Elderly (PACE) Medicaid programs. This position may at times serve as a backup to the Eligibility Specialist Lead Worker and/or Staff Development (trainer). Two years of experience as an Eligibility Specialist in the North Carolina Medicaid program is preferred. The successful candidate will be able to interpret complex rules and regulations and use sound judgment to make appropriate eligibility determinations. They will also possess the following knowledge, skills, and abilities: Basic knowledge of universal computer technology, standard office procedures, practices, and equipment. Skill in operating a variety of office machines, computers, and applicable software, with the ability to type 40 words per minute or faster. Exceptional organizational skills and the ability to prioritize work effectively within structured time frames and deadlines. Exceptional customer service skills and the ability to communicate clearly and effectively, both orally and in writing, with individuals from diverse social, economic, cultural, and educational backgrounds. Thorough knowledge of at least one ( Family and Children's or Adult) North Carolina Medicaid programs, areas, and functions of assignment, and considerable knowledge of agency and community programs and services. Considerable knowledge of and ability to read, analyze, interpret, and apply federal, state, and county program rules, regulations, and procedures. Ability to work effectively in any assigned line staff position, including all eligibility programs and functions. Ability to understand and follow oral and written instructions and establish and follow detailed work procedures. Ability to perform casework, mathematical reasoning, and computations with speed and accuracy. Ability to prepare and maintain accurate records and reports. Ability to thrive in a team-oriented environment while maintaining composure and keeping emotions in check, even in difficult or stressful situations. Ability to maintain regular and reliable attendance. Ability to establish and maintain effective working relationships with colleagues, community partners, and the general public. The individual must support the Forsyth County Guiding Principles of We Care: Integrity, Awareness, Accountability, Respect, and Excellence. Graduation from high school or GED. Twoyears of experience preferred as anEligibility Specialistwith knowledge of public assistance programs as well as a concentration in two or more of the following: Medicaid Lead Worker, Family & Children Medicaid program, Adult Medicaid program, Non- Emergency Medicaid Transportation, Medicaid Call Center, Medicaid Outreach, and Outstation as well as a strong knowledge of NC FAST. A higher education level may be considered as a substitution for all or part of the experience requirement. Advanced communication skills and customer service experience are preferred. Two years of NCFAST experience preferred. Bilingual skills (English/Spanish) are a plus.

Requirements

Basic knowledge of universal computer technology, standard office procedures, practices, and equipment.
Skill in operating a variety of office machines, computers, and applicable software, with the ability to type 40 words per minute or faster.
Exceptional organizational skills and the ability to prioritize work effectively within structured time frames and deadlines.
Exceptional customer service skills and the ability to communicate clearly and effectively, both orally and in writing, with individuals from diverse social, economic, cultural, and educational backgrounds.
Thorough knowledge of at least one ( Family and Children's or Adult) North Carolina Medicaid programs, areas, and functions of assignment, and considerable knowledge of agency and community programs and services.
Considerable knowledge of and ability to read, analyze, interpret, and apply federal, state, and county program rules, regulations, and procedures.
Ability to work effectively in any assigned line staff position, including all eligibility programs and functions.
Ability to understand and follow oral and written instructions and establish and follow detailed work procedures.
Ability to perform casework, mathematical reasoning, and computations with speed and accuracy.
Ability to prepare and maintain accurate records and reports.
Ability to thrive in a team-oriented environment while maintaining composure and keeping emotions in check, even in difficult or stressful situations.
Ability to maintain regular and reliable attendance.
Ability to establish and maintain effective working relationships with colleagues, community partners, and the general public.
Graduation from high school or GED.

Nice To Haves

Two years of experience as an Eligibility Specialist in the North Carolina Medicaid program is preferred.
Twoyears of experience preferred as anEligibility Specialistwith knowledge of public assistance programs as well as a concentration in two or more of the following: Medicaid Lead Worker, Family & Children Medicaid program, Adult Medicaid program, Non- Emergency Medicaid Transportation, Medicaid Call Center, Medicaid Outreach, and Outstation as well as a strong knowledge of NC FAST.
A higher education level may be considered as a substitution for all or part of the experience requirement.
Advanced communication skills and customer service experience are preferred.
Two years of NCFAST experience preferred.
Bilingual skills (English/Spanish) are a plus.

Responsibilities

Gathers and reviews household income, financial resources, and residency information; computes budgets as required.
Reviews forms and other application documents; verifies information through telephone calls and written correspondence with local government agencies, employers, attorneys, representatives, and other relevant contacts.
Explains program requirements and options to applicants; advises or refers clients to other programs or services as appropriate.
Informs clients of their rights and obligations as prescribed by program policies.
Responds to inquiries from clients and the general public regarding benefits, the application process, and program eligibility; provides information and assistance as needed.
Computes and authorizes benefit amounts for assigned programs.
Navigates various complex computer systems to enter and retrieve data from applicable state and county systems.
Documents all actions and case information in the electronic case record.
Operates computers, scanners, calculators, and other standard office equipment used to maintain records.
Provides Adult and Aging Services social workers with pertinent information gathered during applicant interviews and ongoing case maintenance.
Participates in ongoing training as required.
Participates in teams, committees, job fairs, off-site application events, and outreach activities as assigned.
Performs related duties as required.
Assists with vacant caseloads as backup when needed.
Interviews clients to obtain required information.
Interacts daily with internal and external customers in person, by phone, virtually, and via email.
Explains program requirements; completes initial applications; verifies information obtained from clients; and determines program eligibility.
The role requires extensive daily use of a computer and various systemsto determine Medicaid eligibility.