Benefit Programs Specialist II – Medicaid

Responsibilities

• Interview applicants/recipients, adapting techniques to meet the needs/abilities of the client.
• Determine eligibility for assistance and benefit levels using automated systems and manual methods.
• Process applications for benefit programs such as SNAP, Medicaid, Temporary Assistance to Needy Families (TANF), Energy, General Relief, Auxiliary Grants, Refugee Cash, and/or Medical Assistance.
• Compile and analyze information and policy to determine and redetermine ongoing eligibility for financial, medical and other governmental programs.
• Compute income and resource eligibility timely, accurately and completely based on complex state and federal guidelines.
• Ensure clients receive maximum eligible benefits.
• Explain available benefit programs, rights and responsibilities, other agency services and community resources.
• Identify social problems and make referrals to social workers as needed.
• Research, interpret, and apply mandated programmatic policy and procedures based on state and federal guidelines in the administration of a benefits caseload which may be generic or specialized.
• Maintain integrity in benefits delivery and caseload management by keeping records according to established guidelines and identifying errors/potential fraud, making appropriate referrals.
• Evaluate consistency and completeness of data secured, and where indicated substantiate its accuracy.
• Respond to appeal requests, prepare appeal summaries and supporting documentation, and participate in appeal hearings.
• Attend and participate in unit and agency meetings, sharing knowledge, experiences and information.
• Participate in agency work groups and/or teams.
• Attend and participate in ongoing training, learning and growth opportunities.
• Recommend changes in internal policy and procedures based on experience and knowledge.
• Perform related tasks as required.

• High school diploma supplemented with additional training and related work experience, or equivalent combination of training and experience.
• Bachelor's degree (strongly preferred, but not required).
• Direct eligibility experience (preferred).
• Experience working effectively and successfully within a team (preferred).
• Experience working with populations with limited English proficiency (preferred).

Demonstrates expertise in determining eligibility for various benefit programs, ensuring clients receive maximum eligible benefits while maintaining compliance with state and federal guidelines. Proficient in case management, data analysis, and effective communication with diverse populations.