Eligibility Specialist

Benefits and Eligibility Specialist

The Arizona Health Care Cost Containment System (AHCCCS), Arizona's Medicaid agency, is driven by its mission to deliver comprehensive, cost-effective health care to Arizonans in need. AHCCCS is a nationally acclaimed model among Medicaid programs and a recipient of multiple awards for excellence in workplace effectiveness and flexibility.

AHCCCS employees are passionate about their work, committed to high performance, and dedicated to serving the citizens of Arizona. Among government agencies, AHCCCS is recognized for high employee engagement and satisfaction, supportive leadership, and flexible work environments, including remote work opportunities. With career paths for seasoned professionals in a variety of fields, entry-level positions, and internship opportunities, AHCCCS offers meaningful career opportunities in a competitive industry.

Come join our dynamic and dedicated team.

Job Summary:

Benefit & Eligibility Specialists (BESs) are responsible for making financial eligibility determinations for Medicaid programs. BESs provide customer service to diverse populations in a variety of settings that may include in person, phone, and/or call center.

Major duties and responsibilities include but are not limited to:

• Completing financial eligibility determinations for ALTCS, SSI MAO, Medicare Savings, Kids Care, Specialty Medicaid and the FTW programs following productivity, timeliness, and quality guidelines. Scheduling and conducting interviews. Communicate with customers after the interview to include requesting information, status updates and final decision.
• Requesting eligibility verification from multiple sources and reviewing documentation in various systems.
• Researching, following, and applying prescribed policies and procedures.
• Documenting throughout the application process as needed, actions taken, relevant case information, and eligibility related material in case records until final case determination is made using HEAplus system.
• Participate in team meetings, AMS Process improvement, and assisting with special projects.

Knowledge, Skills & Abilities (KSAs):
Knowledge:

• A call center environment.
• Medicare and Medicaid Programs.
• State and Federal rules and statutes.
• ALTCS, SSI MAO, Medicare Savings, Kids Care, Specialty Medicaid, and the FTW financial eligibility policies and procedures.
• Budget calculations used to determine eligibility.
• Community resources.
• Arizona Management System (AMS).

Skills:

• Written and verbal communication.
• Conducting research.
• Investigative interviewing techniques.
• Two way interaction and exchange of information with customers either face to face or over the phone.
• Interpersonal relationships.
• Problem solving and decision making.
• Manage multiple tasks in a caseload.
• Self-prioritize job functions as needed.
• Mathematical calculations.
• Phone etiquette.

Abilities:

• Organize and prioritize a caseload.
• Communicate both verbally and in writing.
• Effectively document actions taken and decisions made.
• Accurately calculate mathematical equations.
• Apply current laws, rules and regulations in making eligibility determinations.
• Determine share of cost amounts.
• Interview effectively when dealing with all community populations.
• Apply customer service techniques; empathy, active listening, and remaining calm during customer interactions.
• Efficiently interact with family members and other entities.
• Effectively organize and prioritize tasks.
• Use logic and problem solving techniques.
• Analytical skills.
• Use numerous computer databases, systems, and programs to include HEAplus, PMMIS, ACE, FORTIS, AZTEC, Right Fax, Microsoft, email and word processing applications.
• Work with minimal supervision.
• Work in an inbound automatic call distributor (ACD) environment.

Selective Preference(s):
Minimum:
Must have a high school diploma or General Equivalency Diploma (G.E.D.) and 6 months customer service related work experience. Must successfully pass a test appropriate to area of assignment. Chinle office only:
Bilingual (fluent) in Navajo. Preferred: 1 year customer service related work experience. Bilingual (Spanish) a plus but not required.

Pre-Employment Requirements:

- Successfully pass…