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Job Description
Essential Job Functions:
25% Responsible for coordination of all CSHCN eligibility procedure/processing in the Region. Performs complex reviews of applications for determination of program eligibility including evaluating applications and supplemental information for eligibility bases on financial, residency, age and medical criteria; performs complex data entry; interviews applicants and collateral sources as necessary to follow-up incomplete applications.
25% Provides technical assistance to regional social work staff, CSHCN providers and/or potential providers concerning provider enrollment, authorization and claims processing. Assists case managers in the resolution of problems between clients, providers of services, and regional staff. Works directly with providers to obtain authorizations for services and filing claims as needed. Provides interpretation of relevant changes as they occur. May interview and provide guidance and assistance to clients with completion and submission of eligibility applications for Medicaid/Medically Need Program and CHIP, assuring compliance with timelines mandated by the CSHCN Program. Answers or returns all telephone or email inquiries regarding eligibility status by providing prompt and correct information on CSHCN rules and individual cases.
15% Maintains accurate files on all cases: approved, denied and incomplete. Documents case data and enters records of findings and determinations; completes various standard forms. Generates and sends correct eligibility letters to program applicants. Prepares workload reports and other special and routine reports in a timely manner. Maintains related records. Prepares and assembles case records; distributes according to geographic area. Researches and compiles regional statistics related to CSHCN eligibility processing by reviewing various printouts, determination summaries and weekly production reports.
15% Functions as team leader to CSHCN Eligibility Specialist (Human Services Specialist I) in accordance with agency and program policies. Reviews and approves travel. Participates in the Performance Evaluation Process.
10% Works with local health agencies, private physicians, individuals, and community action groups to enhance awareness of prevention of chronic diseases and childhood disabilities. Provides information to potential clients about agency programs and services and distributes published materials outlining eligibility requirements. Serves as an information and referral source to the public regarding appropriate community resources.
5% Provides new social work and clerical staff with orientation and training in the eligibility determination process.
5% Other duties as assigned – Other duties as assigned include but are not limited to actively participating and/or serving in a supporting role to meet the agency’s obligations for disaster response and/or recovery or Continuity of Operations (COOP) activation. Such participation may require an alternate shift pattern assignment and/or location. Other duties as assigned by Manager of Specialized Health/Social Services or designee.
25% Responsible for coordination of all CSHCN eligibility procedure/processing in the Region. Performs complex reviews of applications for determination of program eligibility including evaluating applications and supplemental information for eligibility bases on financial, residency, age and medical criteria; performs complex data entry; interviews applicants and collateral sources as necessary to follow-up incomplete applications.
25% Provides technical assistance to regional social work staff, CSHCN providers and/or potential providers concerning provider enrollment, authorization and claims processing. Assists case managers in the resolution of problems between clients, providers of services, and regional staff. Works directly with providers to obtain authorizations for services and filing claims as needed. Provides interpretation of relevant changes as they occur. May interview and provide guidance and assistance to clients with completion and submission of eligibility applications for Medicaid/Medically Need Program and CHIP, assuring compliance with timelines mandated by the CSHCN Program. Answers or returns all telephone or email inquiries regarding eligibility status by providing prompt and correct information on CSHCN rules and individual cases.
15% Maintains accurate files on all cases: approved, denied and incomplete. Documents case data and enters records of findings and determinations; completes various standard forms. Generates and sends correct eligibility letters to program applicants. Prepares workload reports and other special and routine reports in a timely manner. Maintains related records. Prepares and assembles case records; distributes according to geographic area. Researches and compiles regional statistics related to CSHCN eligibility processing by reviewing various printouts, determination summaries and weekly production reports.
15% Functions as team leader to CSHCN Eligibility Specialist (Human Services Specialist I) in accordance with agency and program policies. Reviews and approves travel. Participates in the Performance Evaluation Process.
10% Works with local health agencies, private physicians, individuals, and community action groups to enhance awareness of prevention of chronic diseases and childhood disabilities. Provides information to potential clients about agency programs and services and distributes published materials outlining eligibility requirements. Serves as an information and referral source to the public regarding appropriate community resources.
5% Provides new social work and clerical staff with orientation and training in the eligibility determination process.
5% Other duties as assigned – Other duties as assigned include but are not limited to actively participating and/or serving in a supporting role to meet the agency’s obligations for disaster response and/or recovery or Continuity of Operations (COOP) activation. Such participation may require an alternate shift pattern assignment and/or location. Other duties as assigned by Manager of Specialized Health/Social Services or designee.