DSHS HCLA Public Benefits Specialist 4

State of Washington•Multiple Locations Statewide, WA

About The Position

DSHS HCLA – Public Benefits Specialist Home & Community Services plans, develops, and provides an array of long-term services and supports (LTSS) to persons age eighteen and older with disabilities, seniors, and caregivers. LTSS are intended to maximize independence, dignity and quality of life of these individuals. This is the senior/specialist level of the Public Benefits Specialist series. The position independently provides intensive and expert eligibility services to high-risk clients, who are financially and medically dependent upon the full range of LTSS, while complying with all confidentiality requirements. The position reviews applications and conducts interviews to determine initial eligibility and/or re-determine eligibility for LTSS. Processes changes in client circumstances, implements Federal and State regulations, and determines the effect on the continuing eligibility of clients. Incumbents have completed an extensive training program, which includes advanced level on-the-job instruction and classroom training.

Requirements

A bachelor's or master's degree AND twelve months of experience as a Public Benefits Specialist 3.
A bachelor's degree or higher AND twelve months of experience as a Public Benefits Specialist 2 determining eligibility for long-term care services.
Equivalent combination of experience totaling five or more years.
Qualifying experience must include examining or processing loan applications, medical insurance or rehabilitation claims, unemployment insurance claims, financial eligibility determination, or analyzing, verifying, and evaluating financial information.
The selected candidates must also complete the agency’s Public Benefits Specialist Training Program.
Out-of-state experience conducting financial eligibility determination for public assistance to include financial, medical and food benefit programs will be considered toward experience.

Nice To Haves

State and federal medical assistance programs, Home & Community based waivers, institutional program eligibility, Community First Choice, Medicaid Personal Care, Medicaid Alternative Care, Tailored Supports for Older Adults, Aged, Blind, Disabled cash assistance, Basic Food, and WASHC??.
The philosophy of public assistance programs; State and Federal welfare laws, rules, and regulations principles, problems, and practices of public welfare administration; principles of individual and group behavior, social behavior, social and economic conditions, and their effects upon individuals; office procedures and practices.
The internal functions and process of HCS social services, other Agency and community resources such as Social Security Administration, Veteran's Administration, Third Party Liability process, Area Agencies on Aging, Home Health Agencies, Hospice, Adult Protective Services, and Office of Fraud & Accountability, Community Services Division, Developmental Disabilities Division, and the Health Care Authority, to provide options and appropriate referrals for both recipients and parties who do not qualify for services but still-need assistance from other agencies.
Office procedures and practices and ability to utilize basic office equipment (fax, phone, copier etc.)
The administrative hearing rights of clients.
Specific DSHS systems and databases, such as ACES, ACES On-Line, Barcode, DMS, DOL, Electronic Benefits Transfer, RCN, CARE, Audit 99 and the Financial QA tool, etc.

Responsibilities

Independently determines and re-determines ongoing eligibility for programs such as: HCB Waiver Services, hospice, alternate care service programs, nursing facility, institutional care, Medicaid Personal Care, and Community First Choice.
Expedites eligibility in emergent situations, including but not limited to: expedited food assistance, facility closure, hospital discharges.
Conducts intensive in-person and telephone interviews with the client, client representatives, attorneys, guardians, etc. to determine eligibility and post-eligibility for long-term services and supports, financial, medical, WASHCAP, and food assistance benefits.
Determines accurate benefit eligibility by obtaining and calculating the clients' income and resources using complex guidelines of federal and state sources.
Determines the amount an individual must pay toward the cost long-term services.
Recognize and recalculate incorrect payments of grants, food benefits, medical assistance, and long-term services and supports, and establishes overpayments and underpayments.
Provides professional case management and evaluates services for a broad range of clients seeking long-term services and supports.
Works closely with Home and Community Services social services and Area Agency on Aging case management staff to determine start dates for benefits based on determinations that a client meets functional requirements for certain cash and long-term services and support programs.
Acts as a source of information for agency social workers (internal and external), medical providers, guardians, authorized representatives, and attorneys.
Directs clients, representatives, and caregivers to the appropriate person or agency for inquiries or problems that fall outside the scope of expertise of a Public Benefits Specialist.
On behalf of clients, makes referrals to Social Security Administration, Veteran Affairs, and other agencies or community organizations as necessary.
Inputs and receives data using multiple automated systems including: Barcode, ACES Online, ÁCES 3G, ACES Mainframe, Asset Verification System, CARE, ProviderOne, Support Enforcement Maintenance System, Electronic Benefit Transfer Program, TPX Retirement Systems, and Department of Health interface.
Maintains confidentiality of automated client data.
Analyzes written and oral information received.
Obtains and reviews necessary data, documentation and verification for each program of assistance as it relates to the recipients specific circumstances.
Reads and interprets Washington Administrative Code WAC, Revised Code of Washington (RCW), procedural manuals, policies, and policy clarifications.
Analyzes various legal documents to determine impact on eligibility for long-term services and support programs such as: annuities, trusts, life care contracts, court orders, insurance policies, burial funds/trusts, deeds, business records, gifting instruments and sales contracts.
Uses a statewide asset verification and real property database to analyze impacts of real property transfers, quit claims and sales and understand applicability to a client's eligibility.
Acts on changes of circumstances and sends required notifications to the client, representative, case manager, and facility within time periods established by Washington Administrative Code.
Assess effect of reported changes on continuing eligibility.
Works within timeframes and deadlines which are dictated by program requirements and adheres to performance measures set by the agency.
Provides testimony or acts as a witness for administrative hearings.