Shire Veteran Jobs

JOB SUMMARY:

Performs eligibility work that requires a strong working knowledge and understanding of eligibility program rules and policies and operation of the current proscribed eligibility computer program(s). Performs duties associated with initial intake and ongoing eligibility determination for Medical Assistant Programs, as described in Colorado Staff Manuals, Volumes III, IVB, and VIII through the Department of Human Services or Department of Health Care Policy and Finance. Interprets rules and regulations of all program areas. Facilitates and/or coordinates the processes and procedures necessary to provide clients with assistance. Performs calculations and accounting functions necessary to establish eligibility and to determine the necessary steps to resolve client situations. Provides referral to other community resources to assist clients. Bilingual English / Spanish is a plus.

ESSENTIAL JOB FUNCTIONS:

Conducts initial and ongoing program eligibility interviews and assessments by phone, face-to-face and gathers information such as income and financial resources. Determines initial and ongoing eligibility for Medical Assistance Programs as described in Colorado Staff Manuals, Volumes III, IV-B, and VIII through the Department of Human Services or Department of Health Care Policy and Finance. Determines eligibility for Expedited Food Assistance.

Approves or denies applications, closes cases as necessary, and notifies clients of decisions in writing. Transfers cases to the appropriate eligibility specialist, team, or closed caseload.

Assists clients in completing forms and obtaining the necessary documentation for program participation. Assesses client needs and makes referrals to other agency and community services.

Screens applications to verify programs being applied for. Uses computerized systems to research current and past assistance status and history. Sets up new case files and properly categorizes household composition.

Maintains a working knowledge of the current proscribed eligibility computer system. Performs data entry functions to ensure that required and relevant information is accurately entered into numerous complex data systems. Processes change forms for continued eligibility determination. As required, verifies all information through computer data banks, pay stubs, contacts with employers and banks, etc. Ensures benefit calculations made by the current proscribed eligibility computer program(s) are accurate in order to reduce/eliminate errors.

Manages workload and paper flow. Processes case changes as they occur. Ensures that all case documents are filed in the electronic case file appropriately and in a timely manner.

Completes required paperwork to restore benefits, provide retroactive payments, and provide supplements. Establishes and computes recoveries and restorations due as a result overpayment or underpayment; notifies fraud investigators when case information indicates that benefits may have been received based on fraudulent information.

Informs recipients/applicants of rules and regulations. Explains rights and responsibilities to clients and provides referrals to non-profit agencies and other service providers to facilitate a comprehensive solution to the client's issues.

Maintains a working knowledge of program rules and regulations. Receives, researches, resolves and clears information on required program reports. Processes program sanctions. Identifies the level and kind of sanction. Provides sanction notification to the client being sanctioned.

Prepares cases for and attends dispute resolution conferences, appeals hearings, or other court cases in person or by telephone to represent the county and to testify to the facts of the case. Ensures documentation is detailed and clear in the case file.

Provides customer service by responding to inquiries regarding programs and services. Handles client compla nts and provides needed information regarding program guidelines.

Shall engage in heavy public contact via client interviews and front window coverage.

May be subject to vulgar, offensive language and behaviors from the public.

Based on workload, may be required to participate in mandatory overtime; such overtime may include evenings and weekends.

Responsible for understanding and demonstrating proficiency in all aspects of the eligibility position including but not limited to: face-to-face client meetings on a walk-in basis, lobby/client interviews, processing of applications and redeterminations, pulling and returning calls, working mail and any other correspondence submitted by clients.

Communicates in a timely and responsive manner with internal teams, community organizations, providers, and State Staff.

Oral and written communications must be clear and effective.

Attends team and division meetings as requested. Works effectively in a team environment, providing assistance to co-workers as needed.

Attends training as assigned.

Attends meetings as a representative of the department; conducts self in