Eligibility Worker - Full-time

About the Department

Position Summary
Performs work determining the eligibility and enrollment of clients for income maintenance and health care programs, identifies the need for related social services, and related work. Must accurately interpret and apply multiple complex policies and procedures outlined in various manuals, DHS bulletins and statutes. Works under limited supervision to make eligibility decisions for all financial assistance programs and collaborates with the Financial Assistance Supervisor or Lead Eligibility worker on complex cases and policy.
Scope of Responsibility
Responsible for the implementation of departmental procedures in determining the initial and ongoing eligibility of clients for multiple income maintenance and health care programs in accordance with continuously changing county, state and federal rules and policies applicable to each program. 

Position Duties

1. Administers Eligibility Determination for Federal and State Public Assistance.
   1. Communicates program requirements and explains application procedure to individuals or groups. 
   2. Conducts complex case evaluations and extensive personal interviews to determine eligibility. Reviews all mandatory DHS Brochures with each client.
   3. Researches and interprets policies and regulations established by legislative statutes and Department of Human Services on eligibility. 
   4. Assess and determine assets and improper transfer of assets in conjunction with attorneys for nursing home or elderly waiver programs.
   5. Reviews and discusses options when clients receive lump sums such as sale of property and rental income for the purpose of Medical Assistance recovery.
   6. Determines eligibility initially and at recertification and for changes in circumstance, of benefits for food, cash, healthcare, childcare, emergency assistance, and county burial programs in accordance with federal, state, and local laws, policies and procedures.
   7. Authorizes expenditures of state and federal dollars.
   8. Utilizes approved telephonic language translators to assist in communication with clients.
   9. Makes appropriate referrals to other community services.
   10. Manually determines Health Care Renewals under the Ex Parte system.  
2. Provides ongoing case management.
   1. Processes required reports and reviews. Records and evaluates personal and financial data obtained from applicants and recipients and accurately inputs all client and case data on MAXIS, MMIS, METS and MEC2 systems. Working with these systems requires workers to manage and maintain a minimum of 16 passwords.
   2. Communicates client changes to appropriate staff.
   3. Composes correspondence.
   4. Conducts interviews for initial and on-going eligibility for public assistance programs, explains program requirements to clients, and obtains necessary verifications. 
   5. Interprets legal documents and determines initial and continued eligibility for a variety of health care, work programs, general assistance, nutritional assistance, childcare assistance, emergency assistance, County Burials and Foster care programs.
   6. Initiates procedures to approve, modify, deny or terminate eligibility and grants for various public assistance programs.
   7. Educates and enrolls clients on managed care and reviews County Access Plan. Assists clients in resolving health plan problems, investigates issues and provides resolutions. Refers clients to Managed Care Advocate if needed.
   8. Responds to client questions, concerns and complaints through verbal and written correspondence.
   9. Prepares and participates in client appeals.
   10. Resolves IEVES, PARIS, New Hire matches and DAIL messages timely and performs accurate updates to case.
   11. Cost Effective Insurance Determinations: Performs complex cost-effective premium analyzes, educates clients on the County voucher system, records in the correct systems to support reimbursements, and processes/ monitors said reimbursement.
3. Identifies potential fraud and makes fraud referrals.  
   1. Prepares cases for administrative disqualification and prosecution.
   2. Calculates over/under payments and establishes claims/supplements.
4. Prepares and participates in appeal hearings and completes case actions as needed.  
   1. Prepares testimony and case document.
   2. Reviews complex situations with attorneys.
   3. Testifies to DHS appeal judges or District Court, as needed.
5. Explains and interprets federal, state, and county rules, policies, and procedures.  
6. Clarifies and explains information regarding financial programs to other agency staff, County Board members, attorneys or authorized representatives.

Additional Functions
     1.    Attends training/educational sessions/meetings/seminars.  
     2.   Performs other duties as assigned or apparent.  Minimum Qualifications

Employee Core Competencies
Quality of Work

1. Maintains a high level of accuracy and attention to detail. 
2. Demonstrates the ability to use resources productively, effectively, and efficiently.
3. Demonstrates the ability to think proactively, anticipates potential problems, and provides workable solutions and alternatives with a ‘can do’ approach.
4. Develops and maintains good working knowledge of job responsibilities and prescribed procedures, which facilitates the efficient performance of duties.
5. Takes initiative to utilize job knowledge to analyze situations, resolve problems, and reach decisions.

Quantity of Work

1. Exhibits good organizational and time management skills: plans and schedules completion of work accountabilities in order of priority, making the most effective use of time. 
2. Self-motivated and works independently: demonstrates willingness to assume new and challenging assignments.
3. Demonstrates ability to work well under pressure, utilizing resources effectively.

Professional Conduct/Integrity

1. Demonstrates knowledge and actions consistent with the County’s values and the County’s code of ethics and conduct. 
2. Demonstrates high moral principles and professional standards with others through truthfulness and sincerity; makes ethical decisions.
3. Shows respect for others’ ideas, perspectives, and styles.
4. Demonstrates appropriate business etiquette and social skills.

Customer Service

1. Provides information, options, and/or solutions to inquiries, concerns, and/or requests from the diverse public in a respectful manner.
2. Maintains the County’s reputation of providing a high-level of customer satisfaction.

Communication

1. Demonstrates the ability to develop and maintain working relationships to produce results, and a work environment that builds rapport and trust. 
2. Communicates professionally and effectively with internal and external customers through spoken and written correspondence, including emails.
3. Maintains confidentiality.
4. Listens well; respects viewpoints different than own.
5. Contributes knowledge, experience, and feedback appropriately to others.

Safety

1. Maintains a safe work environment by complying with County safety policies and procedures, and attends necessary trainings.
2. Performs duties with consideration to minimize risk. Reports safety concerns to appropriate parties. 

Accountability and Dependability

1. Adheres to all County policies and procedures.
2. Competently performs all required job duties.
3. Maintains an acceptable record of work attendance, and punctuality in accordance with County and Department requirements.

Other Qualifications

1. Thorough knowledge of organization, department policies, ordinances, laws, practices, procedures, department legal guidelines, recommendations and best practices.
2. Thorough knowledge of financial assistance programs and requirements. Ability to perform mathematics.
3. Knowledge of state and federal policy.
4. General knowledge of the principles and practices of public social service organizations. 
5. General knowledge of current social, economic and health problems.
6. Ability to interpret complex policy, complete research and troubleshoot software programs to get he anticipated eligibility.
7. Knowledge of Interviewing techniques.
8. Ability to exercise professional judgement, critical thinking and in-depth analysis of information collected from clients and data sources to ensure program integrity.
9. Ability to prioritize and organize tasks; handling multiple interruptions to ensure performance standards are achieved.
10. Knowledge of agency programs, services, policies, procedures and organization.
11. Knowledge of community resources.
12. Knowledge of laws and ethics pertaining to data privacy.
13. Ability to explain laws or legal processes to a variety of audiences.
14. Ability to interpret a variety of instructions furnished in written or oral forms.
15. Ability to establish and maintain effective working relationships with others.
16. Ability to work with community partners, public, attorneys, Department of Employment and Economic development, workers compensation, medical providers, public health, court services, law enforcement, Social Security Administration, Internal Revenue Services, financial institutions, employers, employment services, communication action partnerships. Housing agencies, schools and other local and state agencies.
17. Ability to maintain records and prepare clear and concise reports.
18. Skill operating office computer equipment and applicable hardware and software.
19. Excellent communication skills, both oral and written, and interpersonal skills as applied to interactions with staff, associates, clients and the general public.
20. Ability to establish and maintain effective working relationships with others.
21. Ability to effectively deescalate hostile situations.
22. Ability to manage information received from customers coming from multiple sources including: phone calls, office contact, workflow system, fax and emails.