Position: Eligibility Specialist
Department: Care Management
Reports to: Enrollment and Eligibility Manager
FLSA Status: Non-Exempt (Full Time 40 hours per week).
• The Medicaid Eligibility Specialist is responsible for coordinating with various agency programs to advocate and assist participants for applying and requalifying for the Medicaid program.
• Responsible for completing and filing Medicaid application, DHS1004, Asset Declaration, Waiver Conversion/Transfer, Waiver Checklist, FAP, and SER for MI Choice Waiver program according to agency standards and requirements of Michigan Department of Health and Human Services (MDHHS).
• Conducts redeterminations for participants’ continued eligibility in the MI Choice Waiver program according to required timelines.
• Coordinates with financial entities, Supports Coordinators, participants, and participants’ families to obtain necessary information and documentation requested by MDHHS.
• Assists in department monitoring program as it relates to quality and auditing of participant eligibility and records.
• Conducts detailed record keeping and chart documentation.
• Supports achievement of Agency’ mission, vision, and reflects its values in work behavior.
• Performs all other duties as assigned.
Education and Experience:
• High school diploma or GED required.
• Associates degree in social services, administrative services preferred.
• Minimum of one year of related experience in a social services, healthcare or non-profit setting is required. Minimum of four years of experience with Medicaid and Medicaid eligibility requirements.
License and /or Certification:
• Current CPR Certification preferred.
• Personality and demeanor to deal with the public and assist participants.
• Flexible and adaptable in various situations and when interacting with many different personalities.
• Basic office skills such as typing and filing.
• Detail-oriented and professional.
• Proficient in Microsoft Office Suite and related software.
• Ability to analyze and diagnose problems and work independently to solve them.
• Excellent organizational skills and attention to detail.
• Ability to operate general office equipment.
• Excellent written and verbal communication skills.
• Ability to maintain confidential information.
The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
• Prolonged periods of sitting at a desk and working on a computer.
• Must be able to lift up to 25 pounds at a time.
• Must be able to travel to offsite assignments.