Senior Eligibility Specialist; Medicaid

Senior Eligibility Specialist

The Senior Eligibility Specialist, under general supervision, is responsible for serving in eligibility roles in a County Department of Social Services. The eligibility programs involved include Food and Nutrition Services, Temporary Assistance to Needy Families (TANF [Work First in NC]), Medicaid, County Special Assistance, and Subsidized Childcare. Employees serve in one of the following roles: (1) A lead worker over eligibility caseworkers or as lead worker over a unit of a single program area which performs all functions (i.e., intake, processing, and review).

Work may also include performing the same eligibility determination functions as the Eligibility Specialists and Technicians. Employees are required to spend at least 25 percent of their time in a lead worker capacity. (2) Performing a wide range of tasks in the eligibility determination/re-determination process which require an in-depth knowledge of all eligibility programs and functional processes. Work also involves the resolving of client appeals of actions taken by eligibility caseworkers, the analysis of program-wide problem areas which include recommendations for corrective action and the training of new and transitional employees for specialized programs (i.e., LIEAP).

(3) Performing eligibility determinations and ongoing caseload management in Long Term Care Medicaid and Special Assistance. (4) Functioning with a great deal of independence in a hospital or medical setting with the responsibility for performing a variety of complex tasks and functions in the Medicaid programs which include performing two or more functions in the long-term care programs. Employees assume responsibility for the resolution of complex problems where the consequence of their action can have a considerable effect on the client, the medical institution and/or the agency.

Employees are viewed by the medical institution's administrative staff as the primary contact for problem resolution.

Performs difficult work involving the determination or redetermination of the eligibility of applicants or recipients requesting financial, medical or specializing in Long Term Care Assistance, Special Assistance, Program of All Inclusive Care for the Elderly (PACE), Community Alternative Program (CAP), or Adult Medicaid through the Department of Social Services. Gathers and reviews household income, financial resources, and residency date, to compute budgets.

Reviews forms, verifies information through telephone calls, and correspondence with local government representatives, employers, attorneys, and other similar contacts. Explains program requirements and options and advise or refer client to other programs or services as appropriate. Processes the applications of clients applying for benefits. Advises and counsels lower level staff on policies and regulations of the income maintenance program(s) which affect the more complex cases.

Determines and/or re-determines client eligibility for the Eligibility programs. Processes client applications for all other income maintenance programs and the provision of technical expertise to hospital administrators and professional staff on issues impacting upon client eligibility for medical assistance as provided by the Medicaid programs. Refers to the Eligibility program manuals in performing functions required to complete the eligibility determination process.

Responds to inquiries from clients and citizens regarding benefits, application process, and/or program eligibility: provides information and assistance. Produces weekly and monthly reports. Trains newly hired caseworkers on Eligibility program policy, NC FAST navigation, various third party systems, and…