Eligibility Specialist

EXAMPLES OF DUTIES:

• Communicate information to clients during orientations; interpret and explain OHP, Food Stamps, Medicaid, Medicare, and complex policies and procedures of federal, state, and county programs ensuring clients receive benefits for which they are eligible.
• Assist clients to identify their health service needs and access program services; provide information and referral services during orientation; research, interpret, and explain policies and guidelines for the Oregon Health Plan, Food Stamps, Medicaid, Medicare and similar programs; conduct outreach, screening, and follow-up for eligible clients.
• Interview clients to determine needs and obtain required verification; identify unmet health care, financial, and social service needs; coordinate and refer clients to appropriate county service providers and community partner agencies that provide services to diverse and disadvantaged populations; maintain contact with clients to ensure continued eligibility; identify clients whose needs have changed in partnership with health care providers and other personnel; advocate for at risk and vulnerable clients; work with agencies regarding client enrollment in mental health treatment program and eligibility based on mandated treatment.
• Document and record client income, resources, and current situation on required forms; assess forms for accuracy; complete required documentation and benefit-generating actions; update insurance information; maintain case files and records; may determine eligibility for county programs and set pay levels for customers; respond to client inquiries.
• Provide information and education regarding health plan choices to clients and family members, and uninsured or underinsured populations; serve as an advocate for clients with managed health care plans to ensure medical needs are met; respond to inquiries for billing and service issues from clients, medical providers, hospitals, and other health care professionals.
• Arrange for medical, health care, financial, and social service assistance to individuals with complex social and/or medical problems requiring ongoing services.
• Provide detailed information to at risk and homeless populations regarding shelters, showers, food, clothing, and mail; respond to crisis situations involving clients; report possible protective service matters and provide information to investigator.
• Perform other duties as assigned.

LEVEL AND TYPE OF WORK AND/OR SUPERVISION:

Eligibility Specialist

• Entry level
• Paraprofessional
• Perform the full range of duties, working independently, applying well-developed subject knowledge, and exercising judgment and initiative.
• Receive occasional instruction or assistance as new or unusual situations arise.
• Fully aware of the operating procedures and policies within the work unit.
• Work is reviewed based on compliance, appropriateness, and effectiveness in meeting goals and deadlines.
• Receive general supervision from manager or staff.

MINIMUM QUALIFICATIONS GUIDELINES:

Any combination of experience and training that would likely provide the required knowledge, skills, and abilities is qualifying. Requirements are determined at the time of recruitment based on responsibilities of the individual position and business needs of the department.

Eligibility Specialist

Training and experience for entry level, paraprofessional classifications are typically equivalent to an associate's degree and up to one (1) year of experience that demonstrates the ability to perform the duties of the position. (Equivalency 2-3 years of qualifying training and/or experience).

Depending upon assignment, candidates may be required to pass a criminal background check, have a valid driver license, and/or additional training, licenses, or certificates.