Eligibility Specialist III

Forsyth County; Winston-Salem (NC); On-site; USD 40,000 - 52,000; Full time

Job summary

Forsyth County Department of Social Services seeks a qualified Eligibility Specialist to assist individuals and families with seeking Medicaid benefits at a partnering hospital. Responsibilities include accepting, reviewing, and processing FCMA and Adult Medicaid applications in a hospital setting.

The ideal candidate will interpret Medicaid rules, exercise sound judgment on eligibility decisions, and maintain strong organizational and time-management skills while working under deadlines and in

Qualifications

• High school diploma or GED is required.
• Two years of experience as an Eligibility Specialist or closely related experience is required.
• Excellent verbal and written communication skills are required.
• Candidates must attend state and local trainings regarding program requirements.
• Commitment to integrity, accountability, respect and excellence is essential.

Responsibilities

• Interview applicants and gather/verify required documentation.
• Determine eligibility per federal and state Medicaid policies.
• Process applications within established timeframes and respond to inquiries.
• Work independently in a hospital setting while coordinating with the Department of Social Services.

Education

High school diploma or GED

Two years of experience as an Eligibility Specialist or closely related experience

Job description

General Statement of Duties

The Department of Social Services is seeking highly motivated, dependable professionals with advanced communication skills and exceptional customer service abilities to serve in an outstationed position at one of our partnering hospitals. This position is responsible for providing on-site assistance to individuals and families seeking Medicaid benefits, including accepting, reviewing, and processing Family and Children's Medicaid (FCMA) and Adult Medicaid applications.

Distinguishing Features

The successful candidate must be able to interpret complex Medicaid rules and regulations, exercise sound judgment in making appropriate eligibility decisions, and demonstrate exceptional organizational and time-management skills. The individual must also possess the ability to perform basic mathematical calculations, work efficiently within established deadlines, demonstrate proficiency with computer technology and general office equipment, and thrive in a collaborative, customer-focused environment. Strong interpersonal skills, adaptability, and the ability to work independently in a fast-paced hospital setting are essential for success in this position.

Minimum Education And Experience

Graduation from high school or GED and two (2) years of experience as an Eligibility Specialist or closely related experience.

A higher education level may be considered as a substitution for all or part of the experience requirement.

Excellent verbal and written communication skills are required for these positions.

The candidates selected for these positions will need to be able to attend state and local trainings in regards to program requirements.

The ideal candidate will demonstrate strong organizational skills, flexibility, professionalism, accountability, and a commitment to the WeCare principles of Integrity, Awareness, Accountability, Respect, and Excellence.

Essential Duties And Responsibilities

• Work includes conducting applicant interviews, gathering and verifying required documentation, determining eligibility in accordance with federal and state Medicaid policies,
• processing applications within established timeframes, and responding to inquiries from applicants, hospital personnel, and community partners.
• The employee will work independently in a hospital setting while maintaining effective communication and coordination with the Department of Social Services to ensure timely and accurate eligibility determinations.
• This position calls for the ability to work in a fast-paced, continuously evolving environment.
• The ability to communicate with customers from diverse backgrounds