Eligibility Specialist

Job Description:

This position requires someone who can gather information AND likes working with numbers policies and people to determine eligibility for social service programs.

We look for individuals in our organization who are passionate about our mission and values and providing excellent customer service.

We value our employees working closely with them to help them be successful. We value the people we provide services to ensuring they receive the highest quality of customer service.

Recruitment #:

Closes: April 4 2025 (Internal)

Location: Woodburn OR

Salary: Starting at $4307 with excellent benefits. (See below)

Agency Sponsored: Medical/Dental 100 paid for employee and 9098 for dependents generous paidtime off Public Employee Retirement (PERS) Employee Assistance Plan Long Term Disability great culture.

Employee paid: Deferred Compensation Life Insurance Short Term Disability Colonial Life Supplemental Plans Legal Shield.

PURPOSE OF JOB

Meets Agency Mission Vision and Values by determining financial eligibility for benefits and enrolling consumers and ongoing maintaining of consumer enrollment in various medical assistance programs.

Essential Functions

1. Determine eligibility for participation in financial medical and SNAP benefits

2. Conduct annual reviews of financial eligibility for participation in financial medical and SNAP benefit programs

3. Provides ongoing consumer maintenance

4. Provides additional assistance to consumers as needed

5. Promotes person centered services

6. Protects consumers and reduces Agency risk

7. Provides excellent service in a professional manner

1. Determine eligibility for participation in financial medical and SNAP benefit programs by:

• Interview individuals via phone or in person to gather necessary information.

• Explain benefits and resources available.

• Review application document for completeness (may include helping individual through application process).

• Assist applicant in obtaining verifications.

• Collaborate and coordinate with others including Department of Human Services Oregon Health Authority Coordinated Care Organizations attorneys behavioral health partners pharmacies Social Security Administration Medicare medical providers etc.

• Process forms and documents.

• Apply program rules and policy to determine if individual qualifies for programs.

• Provide notification of eligibility decisions timely and completely as outlined in rules and policy.

• Maintain electronic and paper consumer files.

• Cover incoming calls on eligibility for unit i.e. Worker of the Day.

2. Conduct annual reviews of financial eligibility for participation in financial medical and SNAP benefit programs

• Ensure consumer receives redetermination information.

• Review returned materials for completeness.

• Contact consumer for additional information or to clarify as necessary.

• Apply program rules and policy to determine if individual continues to qualify for program.

• Provide notification of eligibility decisions timely and completely as outlined in rules and policy.

• Maintain electronic and paper consumer files.

• Process information forms and documents between determinations to ensure consumer benefits are current.

3. Provide ongoing consumer maintenance

• Receive review and process updated information from consumers.

• Adjust benefits as needed.

• Verify information.

4. Provide additional assistance to consumers as needed

• Process and review forms and data related to MMIS database.

• Provide addition resources and community referrals as appropriate.

• Attend consumer hearings and providing testimony as necessary.

• Process other reports as necessary such as reporting deceased consumers monthly reports to manager on closed denied and withdrawn cases.

5. Promote person centered services

• Embrace and exhibit the Agency Mission and Core Values.

• Understand the role of consumer choice.

• Interact with the public consumers coworkers and others in a patient respectful and culturally appropriate manner.

• Educate self and others of resources available for populations served including researching electronic and written materials and Aging and Disability Resource Connection of Oregon resource database.

• Understand other Agency resources and accessing resources and assistance to consumers as needed

6. Protects consumers and reduces Agency risk

• Follow policies regulations and requirements of project and Agency; document plan and progress as required.

• Serve as a Mandatory Reporter of suspected abuse of vulnerable populations as required by policy and regulation.

• Maintain and sharing information according to privacy regulations.

7. Provides excellent service in a professional manner

• Meet the needs of consumers follow through meeting deadlines and maintain skills and knowledge to perform the job.

• Apply the required knowledge and skills and exhibit critical thinking and problem solving.

• Exhibit good decision making problem solving and work habits.

• Meet quality standards in accuracy judgment timeliness and following policy and procedure.

• Exhibit good work habits including organizational skills regular attendance working independently seeking and offering assistance when needed.

• Exhibit technology skills related to the work needing to be done (word processing spreadsheets database internet research mail IM phones copiers assessment programs like as CAPS Oregon ACCESS etc.

• Regular attendance to meet the demands of this job and provide necessary services.

Experience and Skills:

MinimumQualifications Education and Experience

A qualified applicant will have a minimum of four 4 years of equivalent combination of education and/or experience which demonstrates the knowledge skills and abilities required to do the essential functions of this job. The following qualifications meeting the minimum requirements will be considered:

• Bachelors degree in social sciences or any related field
• Work or volunteer experience working directly with consumers in social service type settings. Experience can be substituted for education.
• Any combination of related education and relevant work experience equaling at least 4 years.

Knowledge Skills and Abilities

The successful applicant must have the following general skills including the ability to:

• Understand and interpret applicable policies and apply them to problemsolving and decisionmaking in order to serve external and internal customers

• Apply the knowledge and skills in a timely accurate and efficient manner to meet deadlines

• Process a high volume of work with critical deadlines

• Organize and prioritize work to meet required time timeframes

• Multitask

• Collaborate and coordinate with others

• Build relationships and network

• Exhibit excellent interpersonal communication and listening skills

• Exhibit good judgment and use courtesy and tact

• Speak read write and understand English

• Follow verbal and written instruction

• Know and commit to abide by rules governing consumer confidentiality and mandatory reporting

The successful applicant must have the following jobspecificskills including the ability to:

• Learn available services of Agency and other community services

• Apply knowledge of program rules

• Utilize general math skills

• Interview and obtain general and financial information

• Understand the role of the individuals preferences in care success

• Keep up with fast changing rules through training and resources provided by the Agency

• Learn and use database to maintain complete and timely files including data entry and narration of ongoing work

• Meet quality work standards

• Learn and apply general office practices such as confidentiality rules employee records maintenance client records maintenance and agency policies and procedures applicable to the specific program and area of work

• Use extensive businessEnglish skills (grammar spelling and punctuation)

• Operate a personal computer copier fax machine phone and general office equipment etc.

Other Requirements

The successful applicant must have the following skills including the ability to:

• Support the agencys mission ethics and values

• Secure and maintain a valid drivers license in the state of Oregon or an acceptable alternative means of transportation

• Commit to regular attendance as it is required to meet the demands of this job

• Pass a criminal background check successfully

• Maintain and share information according to privacy regulations

• Serve as a mandatory reporter of suspected abuse of vulnerable populations as required by policy and regulation

• Complete necessary work as assigned

WORK ENVIRONMENT/PHYSICAL DEMANDS

This is a fastpaced deadlinedriven position where accuracy efficiency and excellent customer services are essential. Frequent consumer contact high volume detailed work.

This job is performed primarily in the office with possible occasional work in the field.

Office work will be conducted using general office equipment includes substantial sitting and is performed primarily in a cubicle environment with noise and interruptions being on phones and working at a computer. Field work requires travel to clients in a variety of settings homes facilities etc. of varying level of cleanliness and repair. Field work requires driving an Agency car or employee car carrying and using a laptop computer.

These essential outcomes require regular sitting talking hearing computer use; frequently required to use repetitive hand motion handle or feel and to stand walk reach bend or lift up to 25 pounds.

Contact with the public in home or office environments may risk exposure to irrational/hostile behavior contagious diseases or contact with domestic animals.

Reasonable accommodation may be made to enable individuals with disabilities to perform the essential functions.

Classification: Eligibility Specialist

Salary Range: R19

FLSA Status: NonExempt

Unit: 1911

Location: Woodburn

Reports to: Program Supervisor

Union Status: Represented

This job description is a general guide for the job to be performed and does not cover everything. Employees may be required to perform other duties including covering for and in other offices. Employees are expected to follow and perform other jobrelated duties requested by their manager.