Job Description:
****Open internal only to current ACCESS AND ELIGIBILITY (AES) employees****

Medicaid for Elderly & People with Disabilities Advisor IV

Performs complex technical, administrative, and management work for Appeals and Mitigation. Performs complex eligibility determinations for social services programs. Work involves coordinating the review of eligibility files, interviewing clients, documenting client information, determining benefits, verifying case data, explaining program benefits and requirements, and resolving problems and complaints. May train others. Works under general supervision, with moderate latitude for the use of initiative and independent judgment. Completes unit reports, special narrative or statistical reports, and responds to complex, high profile client complaints. Serves as the team lead responsible for mentoring and training of staff, which includes providing direction, support and feedback. Serves as the acting supervisor in the unit supervisor's absence. Performs case reviews to determine validity and accuracy of eligibility determinations made by other staff. Initiates, monitors, and manages service improvement projects and reports on activities. Process appeal request(s) and represent the Agency during the Fair Hearing process. Completes formal reports and narratives for management. Provides general information and assistance to clients regarding programs and application process. Reviews suspected fraud cases and makes referrals to investigators. Job requires detailed oriented individuals with ability to apply complex policies and procedures. This position may require travel up to 30%.

Essential Job Functions:
Attends work on a regular and predictable schedule in accordance with agency leave policy and performs other duties as assigned.  Assists in interpreting policy, completing unit reports, resolving and responding to client complaints. Reviews case records to determine compliance with policies and procedures to identify trends and for corrective action. Assists in developing standards or procedures for assigned area. Interviews clients or authorized representatives to gather information to determine eligibility for benefits. Obtains, verifies, and calculates income and resources to determine client financial eligibility and validate eligibility decisions. Documents case records using automated equipment to form a record for each client. Explains program benefits or requirements to clients. Processes Fair Hearing requests, represents the agency in Fair Hearings, and implements Fair Hearing decisions. Works with clients and/or local office staff to attempt case resolution on disputed case actions. Communicates on an intermediate level with others (internally or externally) to provide, exchange, or verify information, answer inquiries, address issues, or resolve problems or complaints. Manages assigned projects. Must be able to work occasional overtime, as required by management, outside of normal hours of operation, which may include weekends when called upon. Must be able to work in a highly stressful and fast paced environment, under constant pressure to meet required deadlines.

Assists management with unit activities including (but not limited to), completion of case work to include work assigned to other staff, case reading, mentoring, completion of reports and assignments, and monitoring as assigned. Assists with projects related to program initiatives, participate in projects, committees, or workgroups. Performs other duties as assigned and required to maintain the operation of the department.

Knowledge Skills Abilities:
Knowledge of eligibility programs, requirements, and policies. Knowledge of Health Insurance Portability Accountability Act (HIPPA) and Tax Sensitive information regulations. Knowledge of interviewing techniques to obtain personal information, make inquiries, and resolve conflicting statements. Ability to monitor, review and analyze data and reports. Skill in handling and resolving complex case issues. Skill in interpreting and applying agency, state, and federal rules, regulations, policies, and procedures. Skill in the use of automated data systems.

Skill in providing customer services. Skill in effective verbal communications. Ability to screen applications, verify eligibility criteria, and determine case dispositions. Ability to interpret and apply agency, state, and federal rules, regulations, policy, and procedures. Ability to develop and establish effective working relationships. Ability to train and evaluate performance issues. Ability to identify problems and evaluate alternatives. Assists in interpreting policy, training new workers, completing unit reports, responding to client complaints, and acting in the supervisor’s absence. Reads case records to determine compliance with policies and procedures to identity trends and for corrective action. Assists in developing standards or procedures for assigned area. Interviews clients or authorized representatives to gather information to determine eligibility for benefits. Obtains, verifies, and calculates income and resources to determine client financial eligibility. Develops payment plans to facilities to ensure accuracy of payments. Documents case records using automated equipment to form a record for each client. Explains program benefits or requirements to clients. Manages assigned projects.  

Registration or Licensure Requirements:
N/A

Initial Selection Criteria:
High School diploma or GED equivalent is required. Sixty (60) hours credit from an accredited college or university is required OR relevant work experience may be substituted for college credit on a year for year basis. Degree from an accredited college or university is preferred. A minimum of fou years’ experience as a Medicaid for Elderly & People with Disabilities Advisor is required. Prior supervisory or leadership experience preferred. Current TIERS and Eligibility Workload Management System (EWMS) Knowledge is preferred. Current knowledge in eligibility program policy and procedures is required. Knowledge and/or experience of the appeal process is preferred. Ability to work in a professional customer service environment required. Required experience using manual and/or automated systems to determine eligibility for MEPD Medicaid programs. Required experience in evaluating case records in relation to agency standards for quality and timeliness. Required experience in presenting relevant information concerning program policies and objectives to fellow workers, colleagues, clients, and public in a clear and concise manner. Required experience providing mentoring support and assistance to staff. Ability to work beyond normal work hours as needed/required. Ability to accept additional work assignments. Ability to travel 30% of the time.