Eligibility Specialist

TITLE:

ELIGIBILITY SPECIALIST IDEPARTMENT: HCAPFLSA STATUS: NON-EXEMPT

REPORTS TO:

HCAP ASSISTANT MANAGEREFFECTIVE DATE: 8/3/2026

SUMMARY The Eligibility Specialist is responsible for processing requests for healthcare assistance by reviewing applications, conducting interactive interviews, and gathering facts to accurately determine eligibility for HCAP benefits. This position complies with all MCHD and HCAP specific policies and procedures and maintains confidentiality. The Eligibility Specialist is cross-trained in all areas of Eligibility and Enrollment to facilitate timely processing of applications.

ESSENTIAL DUTIES AND RESPONSIBILITIES include the following:

Provide excellent customer service to all applicants and consistently display a high standard of conduct and professionalism.

Obtain, scan and electronically save all applications and eligibility documentation into the I.H.S. software.

Perform interactive interviews of clients or authorized representative to gather eligibility information and clarify ambiguities.

Determine client’s retro or current program eligibility by using the I.H.S software to make computations based on income, resources and household size.

Ensure accuracy and completion of applications and necessary HCAP forms prior to certifying applicants for benefits.

Conduct follow-up contacts with clients to encourage successful completion of application process.

Educate clients on program benefits, including coverage dates, provider network, rights and responsibilities and life of HCAP .Accurately input and update data and/or coverages into software. Verify, update and enter detailed case notes in the software when changes in eligibility occur.

Answer phone calls courteously and in a timely manner to ensure minimal abandonment rate.

Maintain a minimal error rate and maintain productivity levels as determined by established standards and guidelines.

Provide front desk coverage as assigned.

Attend community outreach events as well as local conferences as assigned.

Maintain knowledge of all Medicaid programs and other government-sponsored programs and provide assistance with the corresponding applications when necessary.

Perform other job-related duties as assigned by management.

SUPERVISORY RESPONSIBILITIES This job has no supervisory responsibilities.

MINIMUM QUALIFICATIONS High school diploma or general education degree (GED) required.

Minimum of 3 years’ experience in a similar industry required.

Bilingual (English/Spanish) with strong communication skills preferred.

Effective clerical skills.

SKILLS AND KNOWLEDGEModerate word processing, database, and spreadsheet skills required.

Basic E-mail and internet skills required.

Ability to handle multiple tasks efficiently and effectively.

Excellent oral and written communication skills.

Ability to relate, communicate and engage with diverse populations.

CERTIFICATES, LICENSES, REGISTRATIONS Current Texas Driver's License.

Remain insurable by the current insurance vendor of MCHD.Community Health Worker Certification.

Required NIMS Training as referenced in the Safety & Emergency Management Policy SEM 27-201.

NOTE:

Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Physical Demand Category:

Sedentary Work Audio-Visual & licensing Demands:

Vision (Avg)
Color Discrimination Peripheral Vision Depth Perception Hearing (Avg)
Required License / Certification:
Valid Driver's License Specific Actions

Required:

In an eight hour day, this job may include:

Standing/Walking:
Occasional Sitting: 6-8 Hours Driving:
Occasional Work Environment:

This job may include:

Noise Repetitive Motions:
This job will include:

Simple Grasping Fine Manipulation Pushing & Pulling Finger Dexterity Foot MovementMANEUVERABILITY:

This job will require:

Occasional:

Bending Squatting Twisting Reaching
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