Benefit and Eligibility Specialist 2025-01486
Benefit and Eligibility Specialist 2025-01486
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Job Description
Description and Functions
- GENERAL DESCRIPTION:
This position is responsible for the ongoing monitoring and implementation of the Supports Comprehensive and Community Choices Waivers which are overseen by the Home and Community-Based Services (HCBS) Waiver Programs. The Benefits and Eligibility Specialist works to verify that waiver participants receive services as outlined in their plan of care and that those individuals have access to medical community supports and HCBS waiver services so that their health and safety needs are being met. This position will be responsible for assisting with the waiver eligibility process conducting quality improvement reviews of participants plans of care and supporting the process by which program participants may request additional funding.
Human Resource Contact:
ESSENTIAL FUNCTIONS: The listed functions are illustrative only and are not intended to describe every function that may be performed in the job level.- Assure that each participants Individualized Plan of Care addresses the waiver services that the participants plan of care team identifies meets the participants goals and needed supports respects the participants rights and identifies the participants health and safety needs.
- Provide quality customer services and technical assistance to current and potential waiver case managers and participants colleagues providers stakeholders and the public.
- Communicate with necessary parties regarding changes in rules procedures expectations and goals while ensuring compliance with federal and state regulations.
- Ensuring that waiver participants are funded in accordance with Home and Community Based Services (HCBS) waivers approved by the Centers for Medicare and Medicaid Services Wyoming Medicaid Rules and Regulations and Wyoming Statutes.
- Provide technical assistance to case managers when preparing emergency requests as well as presenting the request to the Extraordinary Care Committee.
- Become a Subject Matter Expert in areas assigned by the supervisor.
- Participate in and facilitate working groups to identify issues and develop policy for implementation.
- Contribute to the drafting of agency rules policies and procedures related to the area.
- Research processes in other states and/or with advocacy groups to help develop policy that will meet the needs of Wyoming participants.
- Coordinate details and processes of adverse actions including administrative hearings.
- Notify the Supervisor and Unit Manager of received reconsiderations promptly to ensure deadlines are met.
- Complete adverse action processes including compilations of documents or correspondence relevant to the action and ensure the Unit Manager receives these promptly.
Qualifications
PREFERENCES:
A BA/BS degree in Social work Human Services Psychology or other related field
KNOWLEDGE:- Excellent Verbal and written communication skills.
- Conflict resolution skills.
- Ability to multitask and manage changing workloads and expectations.
- Knowledge of resources throughout the State including non-waiver services that may assist participants in obtaining needed services.
- Ability to analyze rules and procedures in order to make independent judgments.
- Knowledge of current Medicaid rules and procedures.
- Knowledge of current rules of the Wyoming Office of Administrative Hearings.
- Knowledge of requirements within the current Community Choices and Comprehensive and Supports Waiver documents.
- Knowledge of current practices in the field of Developmental Disabilities.
- Knowledge of community resources for services.
- Familiarity with other agencies that serve individuals who are aged blind or disabled.
- Knowledge of various computer programs.
- Ability to educate and provide technical assistance to stakeholders regarding HCBS Waiver requirements.
- Ability to educate and provide technical assistance to stakeholders regarding Medicaid Rules and Regulations related to the Community Choices and Comprehensive and Supports Waivers.
- Ability to troubleshoot concerns within Waiver programs.
- Ability to analyze data and work with other Division staff to remediate identified problems.
- Ability to prioritize work in order to meet deadlines.
- Know and comply with HIPAA policy and procedures.
- Enter correct and monitor data in electronic systems including input verification and quality checking.
- Knowledge of all state-used databases.
- Knowledge of State and Federal law.
- Ability to work within a team environment.
MINIMUM QUALIFICATIONS:Education:Bachelors Degree (typically in Healthcare)Experience:0-2 years of progressive work experience (typically in Health Programs)OREducation & ExperienceSubstitution:3-5 years of progressive work experience (typically in Health Programs)Certificates Licenses Registrations:NoneNecessary Special Requirements
PHYSICAL WORKING CONDITIONS:This position takes place in an average office work environment.
NOTES:- FLSA: Non-Exempt
- The Wyoming Department of Health is an E-Verify employer.
Supplemental Information
048-Wyoming Department of Health - Division of Healthcare Financing - Waivers & Programs
Clickhere to view the State of Wyoming Classification and Pay Structure.
URL: State of Wyoming is an Equal Opportunity Employer and actively supports the ADA and reasonably accommodates qualified applicants with disabilities.
Class Specifications are subject to change please refer to the A & I HRD Website to ensure that you have the most recent version.
Required Experience:
Unclear Seniority
Employment Type
Full-Time
