Medicaid Specialist Long Term Care I/II-164994

Adams County • Westminster, CO

383d

About The Position

This series of positions determines eligibility for Health First Colorado (formerly Medicaid), including Long Term Care and CHP+. This position works under a contract with a specified community partner. This series of positions may be required to be onsite at various community partner locations.

Requirements

• Knowledge of medical public assistance programs, as applicable.
• Knowledge of CBMS.
• Apply basic math and read, interpret, and apply rules and regulations.
• Communicates clearly and concisely, both orally and in writing.
• Differentiate between relevant and non-relevant information when making eligibility decisions.
• Input data accurately and detect errors/make corrections.
• Skills related to customer service.
• Ability to establish, maintain, and foster positive and harmonious working relationships with those contacted in the course of work.

Nice To Haves

• Bilingual applicants are preferred.
• Satisfactory completion of an Associate's or bachelor's degree in business, behavioral science, or another appropriately related field may substitute for experience on a year for year basis.

Responsibilities

• Examines applications to determine applicants/participants income, resources, household composition and employment status to assess their eligibility for medical assistance.
• Reviews applications for accuracy and completeness and makes requests for information regarding incomplete forms and missing documentation.
• Verifies required information by appropriate methods: e.g., phone calls to employers; applicants; computer database inquiries (interfaces); statistical reports from the State and/or change or status reports turned in by clients to determine program eligibility.
• Explains program eligibility requirements to applicants, including all rules and regulations, his/her rights and responsibilities, available benefit dates, reason for approval or denial and the right to appeal.
• Interface daily with statewide computer system requiring accurate and complete data entry of information.
• Interprets and evaluates computer generated data to determine application to individual case processing for approvals, changes, denials, and discontinuations.
• Utilizes computer daily for inquiry and data entry for preparation of complex correspondence, spreadsheet development and record maintenance and research.
• Maintain client records within the Colorado Benefit Management System (CBMS) and electronic case file in the Department's electronic document management system.
• Document all actions taken on applications and cases within CBMS.
• Completes monthly reports that are instrumental in discovering discrepancies that could affect participant's eligibility.
• Works closely with contracted community partner staff to share relevant information with the support of the supervisor.
• Participates along with supervisor in the dispute resolution process with applicants/participants when requested.
• Prepares evidence, attends, and testifies in state level hearings on applicant/participant appeals.
• Partners with supervisory support with service providers and other agencies to achieve positive outcomes for clients.
• Performs other related duties and responsibilities as required.

Benefits

• Compensation is based on experience and qualifications.

What This Job Offers

• Career Level: Entry Level
• Industry: Oil and Gas Extraction
• Education Level: High school or GED