106 Consumer Benefits Specialist

West Texas Centers MHMR; Big Spring (TX); On-site; USD 40,000 - 55,000; Full time

Job summary

West Texas Centers MHMR is seeking a Medicaid eligibility specialist to screen and assist clients for TANF, Medicaid, and related programs in the Big Spring area. The role involves interviewing clients, verifying financial data, and interpreting Medicaid policies for staff.

You will assist clients through eligibility determinations and hearings, while maintaining strict confidentiality and building trust with consumers and other agency personnel.

Qualifications

• Screen and assist consumers in Medicaid eligibility determinations.
• Schedule and conduct eligibility interviews with consumers.
• Maintain complete records and report daily activities.

Responsibilities

• Obtain applications and screen Medicaid eligibility.
• Track, monitor and assist consumers through the Medicaid process including hearings.
• Enter data in a reporting system and maintain activity records.
• Coordinate Medicaid eligibility information with program and reimbursement staff.
• Maintain confidentiality and professional conduct.

Job description

Performs complex work screening and reviewing applicants for possible TANF, Medicaid, Supplemental Security and Social Security eligibility potential. Work involves interviewing clients, verifying financial information and other case data. Will interpret Medicaid policies for staff, assist in Medicaid training for staff and may review records to determine continuing Medicaid eligibility. Will assist and accompany clients through other agency eligibility determination processes. Will assist clients in hearings and appeal processes. Work requires use of personal initiative, extensive relationship building with other agency personnel and the ability to build trust and confidence with agency consumers.

ESSENTIAL TASKS AND PURPOSES:

• Obtain applications, screen and assist consumers in the Medicaid eligibility process.
  • Schedule and conduct eligibility screening interviews with consumers
  • Obtain and verify consumer Medicaid eligibility information, assist consumer in agency interviews
  • Accompany consumer, if necessary to Medicaid eligibility interviews.
• Follow through on all Medicaid application to final determination, including the hearing process.
  • Track, monitor and assist consumers throughout the Medicaid application process with other agencies
  • Assist in preparation and in some cases, accompany the consumer to hearings and/or appeals
• Create Medicaid eligibility reporting system. Maintain complete record of activity.
  • Enter data in a reporting system which identifies new, current and pending Medicaid applications.
  • Track, record and report daily activities.
  • Reports are submitted within established timeframes.
• Coordinate Medicaid eligibility information with appropriate program staff as well as reimbursement staff.
  • Work closely with program staff to ensure efficient and effective flow of screening and interviewing. Keep program staff informed of eligibility activity.
  • Maintain close contact with reimbursement staff regarding new Medicaid eligibility, ongoing eligibility, denials and appeals.
• Maintain excellent working relationships with all Medicaid related agencies.
  • Develop and maintain cooperative, productive and diplomatic relationships with community, state and federal agencies, particularly those involved with Medicaid.
• Organize and manage workload effectively. Maintain absolutely confidentiality with consumers and other staff as appropriate.
  • Meet Center and other agency deadlines involving Medicaid application timeliness, appeal/hearing timeframes and follow-up verification of information.
  • Will follow rules and guidelines for confidentiality as established by supervisor and WTC requirements. There can be NO non-compliance's regarding this task. Employee must maintain a high level of professional confidentiality at all times.
  • Transferring information only with clear consent to do so.
• Performs other duties as assigned

ESSENTIAL WORK BEHAVIORS:

All employees are expected to comply with all West Texas Centers (WTC) Policies and Procedures. This includes but is not limited to the following:

• WTC Code of Conduct Policy and reporting requirements
• WTC Corporate Compliance Policy, related procedures and reporting requirements
• Abuse, Neglect & Exploitation Policy and reporting requirements
• Standards for Employees Policy
• Property and Equipment Policies and related procedures

Staff will establish and maintain effective work relationships with individuals served and their families, supervisors, co-workers, and visitors by demonstrating cooperative, courteous, and respectful behavior. Staff will adhere to rules outlined in Confidentiality Statement signed by employee and follow Information Services policy/ procedure guidelines related to security and accountability as a user of WTC network and software application technology.

All team members will promote and ensures safety guidelines are followed for the work environment by maintaining clean, neat, organized and safe work areas. This includes but is not limited to the following:

• Safety concerns are reported to supervisor immediately upon discovery and/or corrected.
• Identifies and reports any unsafe factors in the environment.
• Reports and/or corrects safety hazards in the work area.
• Utilizes universal precautions when handling all blood and body fluids.
• Adheres to all standards, policies and procedures of infection control.
• Universal precautions are utilized in accordance to WTC policy and procedures.

Team Members must have and maintain a driving record that is acceptable for insurability through the Center's insurance carrier. Staff must maintain a safe, inspected and road-worthy vehicle and have a valid Texas Driver's License. Staff must notify supervisor immediately of any driving violations or citations received from law enforcement with no evidence of failure to report. Must meet the criteria that indicate a commitment to safe and responsible driving as defined by the Texas Risk Management Fund.