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Eligibility Specialist

Posted on May 18, 2019 by Centro De Salud Familiar

El Paso, TX 79902
Admin & Secretarial
3 May 2019
Annual Salary
Full-Time
Job Title: Eligibility Specialist I. JOB SUMMARY The position of Eligibility Specialist determines initial and continued eligibility for public assistance programs (Ryan White funded programs including the AIDS Drug Assistance Program ADAP). The position may also perform quality control work by reviewing eligibility decisions made by others. Work is done in a fast paced environment that has high standards for customer service and program accuracy. The position gathers sensitive and personal information to make timely and accurate eligibility determinations. Strong interpersonal and conflict resolution skills are necessary as the Eligibility Specialist interacts with people from different walks of life and/or in various emotional states. Forms an open and supportive therapeutic relationship with patients in a bilingual, culturally sensitive manner. Responsible for complying with La Fe's customer relations' protocols and policies in the delivery of daily services. II. ESSENTIAL JOB FUNCTIONS Responsible for greeting and providing courteous assistance to all individuals entering the clinic. Interviews clients, obtains and assesses all necessary facts, data, supporting information, and documentation pertaining to the application or recertification for public assistance. Evaluates information and applies allowable standards and criteria. Explains program eligibility requirements, rules, regulations and individual rights and responsibilities to clients. Reviews and analyzes information for accuracy; identifies inconsistencies; requests necessary documentation; verifies and validates data. Answers inquiries and refers clients to various programs. Identifies potential benefit overpayments, assesses cause for overpayment and makes referrals for recovery of benefits. Identifies potential fraud and reports thru and to the proper channels. Accurately enters data into an automated system and ensures accurate eligibility results. Communicates verbally and in writing with clients, co-workers and other agencies. Performs intermediate mathematical calculations. Maintains confidentiality of all applicant and recipient information. Maintains compliance with policies outlined by state, local and federal regulations. Meets with all potential new ADAP enrollees; explains ADAP program benefits and requirements. Assists clients with the submission of complete, accurate APAP applications. Submits completed applications via the most efficient method available. Responsible for maintaining accurate and current record keeping functions. Establishes and maintains positive interpersonal relationships and keeps line of communication open with health care team and community agencies. Attends and participates in regular departmental, organizational and committee meetings, conferences, workshops, etc. Responsible for the effective administration and/or management of specific wellness projects and programs as assigned. Participates in and/or contributes to community wellness projects and initiatives. Assists with departmental support functions. Performs other duties as assigned. MINIMUM JOB REQUIREMENTS A. Work Experience Must have documented experience (paid, internship and/or as a volunteer) working with Persons Living with HIV/AIDS or other chronic health conditions. Experience in performing intake/eligibility, referral/linkage and/or basic assessments of client needs preferred. B. License/Registration/Certification Must complete all THMP ADAP training modules within 30 days of hire. Must complete all training required of Agency new hires, including any training required by TDSHS HIV Care Services Branch Standards of Care, within established timeframes. Must complete all annual or periodic training or re-certifications within established timeframes. AEWs who will also provide general Ryan White Program Intake/Eligibility services to prospective Agency clients must complete all applicable required training within established timeframes. C. Education Graduation from an accredited four (4) year college or university in a Human Services field (Sociology, Psychology, Family Studies, etc.) and at least two (2) years of full-time experience in a related field (Education and experience may be substituted-one year of college equals one year of experience) or six (6) years of full-time experience in a related field; D. Skills 1. Ability to establish and maintain effective working relationships. 2. Ability to exercise good judgment in unusual or stressful situations. 3. Ability to communicate effectively, both orally and in writing. 4. Ability to work effectively with local, state and national organizations. 5. Ability to represent La Fe in public functions, presentations, organizations, etc. 6. Ability to relate well to persons of all ages and cultures. 7. Must demonstrate the ability to quickly establish rapport with clients in a respectful manner consistent with the health literacy and preferred language. 8. Must demonstrate proficiency in the use of PC-based word processing and data entry. 9. Must demonstrate general knowledge of, or the ability to learn, health care insurance literacy. 10. Bilingual English/Spanish. PHYSICAL JOB REQUIREMENTS Ability to perform essential job functions with or without reasonable accommodations. Category: Administrative , Keywords: Eligibilty Specialist

Reference: 708083416