[Hiring] Eligibility Specialist III @State of Florida

Role Description

This role was formerly the Eligibility Specialist I position with the Specialized Medicaid Center of Excellence within the Office of Economic Self Sufficiency. The position has been upgraded to an Eligibility Specialist III (COE) and determines eligibility for highly complex Medicaid programs for:

• Long Term Care
• Nursing Homes
• Hospice
• Home and Community Based Services (HCBS) waivers
• Disability Determinations

This is an Internal Agency Opportunity and only qualified candidates currently employed with the Department of Children and Families will be considered. This position may be located anywhere in the State of Florida and would be assigned to the Statewide Specialized Medicaid Center of Excellence and may be assigned to a Long-Term Care (ICP) processing or inquiry unit, Disability Determination (DDD) unit.

The primary function is determining eligibility for government assistance programs. This position requires the ability to apply highly complex policy accurately and effectively for the State of Florida’s most vulnerable customers for the SMCOE. The work performed includes processing a broad range of paperwork and entering information into a computer-based eligibility system with very time-sensitive Federal, State, Agency, and Legal deadlines.

Primary duties may include but are not limited to:

• Instructing customers and providers in completion of various forms, and reviewing the applications and forms submitted for completeness and accuracy.
• Determining program eligibility in accordance with current regulations using a computer-based eligibility system.
• Researching case information thoroughly to develop recommendations and alternative solutions.
• Reporting cases where identity theft or fraud is suspected.
• Advising clients and providers of deadlines, time frames, and necessary actions to be taken.
• Working with customers and providers who may not take the necessary actions within the required time frame.
• Establishing and maintaining multiple electronic files and conducting regular reviews and updates.
• Documenting all communications and contacts with customers and providers.
• Managing an electronic caseload that varies based on community needs, ensuring accuracy levels are maintained, and cases are processed within specified time frames.
• Assisting customers and providers with questions or concerns pertaining to eligibility and effectively managing and resolving customer complaints and escalations.
• Staying current with changes in rules, laws, procedures, etc. that affect timeliness and accuracy.
• Assisting in the dissemination of policies and procedures while offering educational support to internal and external stakeholders.
• Providing technical expertise and guidance to support the development, delivery, and assessment of training for human services programs.
• This position may require face-to-face contact with customers and providers.
• Customer Service with goals of problem solving and resolution.
• Performing special work assignments and other related work/duties as required or assigned.

Qualifications

• Two Years Paraprofessional experience in a position where the major responsibility was determining eligibility, conducting interviews, providing counseling, recruiting, billing or collecting accounts, checking credit, processing insurance policies or claims or providing customer service.
• An Associate's degree, or higher from an accredited college or university can substitute for the experience.
• 60 semester or 90 quarter hours can substitute for the experience.
• Minimum of one year work experience in the State of Florida Department of Children & Families Economic Self-Sufficiency Program as an Eligibility Specialist I in determining eligibility.
• Must be willing to travel.

Requirements

• Preference for experience in Specialized Medicaid programs, specifically Long term Care/Institutional Care programs, Hospice, Waivers, and Disability Determination programs.
• Prior experience in a position where the major responsibility was working with legal and/or medical paperwork.

Benefits

• The State of Florida supports a Drug-Free workplace. All employees are subject to reasonable suspicion drug testing in accordance with Section 112.0455, F.S., Drug-Free Workplace Act.
• VETERANS’ PREFERENCE. Candidates eligible for Veterans’ Preference will receive preference in employment for Career Service vacancies and are encouraged to apply.