[Hiring] SENIOR ELIGIBILITY SPECIALIST III @State of Florida

Role Description

This role was formerly the Eligibility Specialist II position with the Specialized Medicaid Center of Excellence within the Office of Economic Self Sufficiency. The position has been upgraded to a Senior Eligibility Specialist III (COE) and may be assigned to a Long-Term Care (ICP) processing or inquiry unit, Disability Determination (DDD) unit, or Department Hearings Representatives unit.

This is a professional position in the Economic Self Sufficiency Program for the statewide Specialized Medicaid Center of Excellence (SMCOE). The primary responsibility is to determine eligibility for various public assistance programs. This involves tasks such as:

• Reviewing cases throughout the different stages of the service delivery model.
• Conducting thorough case reviews to ensure compliance with program requirements.
• Providing training or mentoring for staff to strengthen accuracy rates.

Examples of Work Performed

• Reviewing and analyzing data from quality control and monitoring sources to identify trends, address issues, and provide targeted training to improve staff accuracy and performance.
• Providing training and mentoring to staff to improve accuracy rates and overall performance.
• Conducting mentoring sessions and delivering targeted training in areas where quality issues are identified.
• Performing quality management system reviews, identifying case reading errors, and ensuring timely and accurate corrections to maintain compliance with program standards.
• Planning, evaluating, leading and guiding staff towards continuous quality improvement.
• Participating in the preparation and completion of Ad Hoc reports, ensuring accuracy and timeliness in meeting regional and departmental needs.
• Interacting with applicants, recipients, and other stakeholders, providing excellent customer service.
• Addressing and resolving inquiries and complaints promptly and professionally.
• Representing the Department in hearings, preparing case documentation, completing supervisory reviews, and correcting cases.
• Providing guidance to internal and external stakeholders, explaining processes, addressing questions, and resolving issues efficiently.
• Instructing applicants and providers in completion of various forms, and reviewing the applications and forms submitted for completeness and accuracy.
• Researching case information thoroughly to develop recommendations and alternative solutions.
• Utilizing problem solving and critical thinking by combining, evaluating, and reasoning with information and data to make decisions and solve problems.
• Advising applicants and providers of deadlines, time frames, and necessary actions to be taken.
• Participating in special work assignments and other related duties as required or assigned.

Qualifications

• Knowledge of principles and processes for delivering exceptional customer and personal services.
• Ability to apply the laws, rules, and regulations governing eligibility and grant determination for multiple government assistance programs.
• Familiarity with methods for compiling, organizing, and analyzing data.
• Strong social perceptiveness to recognize and understand others' reactions and underlying motivations.
• Knowledge of problem-solving techniques.
• Knowledge of training principles and practices.
• Ability to perform complex arithmetic operations.
• Ability to conduct thorough fact-finding interviews and accurately prepare and maintain detailed records and reports.
• Ability to establish and maintain effective working relationships with a diverse range of individuals.
• Ability to investigate and effectively respond to customers and providers complaints.
• Ability to compose documents involving technical information.
• Ability to prioritize and meet deadlines.
• Ability to communicate effectively both orally and in writing.
• Ability to apply ethical business practices.

Requirements

• Two years or more of 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 two years case processing experience in the State of Florida Department of Children & Families as an Eligibility Specialist I, with at least one year of eligibility processing experience in specialized Medicaid programs.

Preferences

• Prior experience in a position where the major responsibility was working with legal and/or medical paperwork.