Medicaid Specialist - Project Designated - 166022 - 166040

Posting number: 07618

Department: Human Services

Division: HS Self Sufficiency

Job classification: Medicaid Specialist - PJF

Posting type: Regular

Categories: Administration, Administrative Assistant, Clerical & Data Entry, Code Enforcement, Community Services, Environmental Services, Food Services, Health Services, IT and Computers, Planning and Development, Public Safety, Redevelopment, Social Services, Management, Investigative, Education, Professional, Miscellaneous, Safety, Diversity Management/EEO, Human Services, Community Development, Economic Development, Customer Service, Project Management, Organizational Development, Training, Records Management, Emergency Management, Nutrition, Health Education, Grants Administration, Statistics/Mathematics, Health Sciences, Communications, Development/Fundraising, Medical/Dental, Professional Education, Social Sciences, Community and Social Services, Education, Training & Library, Health Care Support, Office and Administrative Support, Career Exploration, Program Management, Database Administration, Insurance, Financial Aid & Services

Summary

This position determines eligibility for Health First Colorado (formerly Medicaid), including Long Term Care and CHP+. This position may work under a contract with a specified community partner and may be required to be onsite at various community partner locations.    

Examples of duties

• Examines applications to determine applicants/participants income, resources, household composition and employment status to assess their eligibility for medical assistance.
• Reviews applications for accuracy and completeness and makes requests for information regarding incomplete forms and missing documentation. Verifies required information by appropriate methods: e.g., phone calls to employers; applicants; computer database inquiries (interfaces); statistical reports from the State and/or change or status reports turned in by clients to determine program eligibility.
• Explains program eligibility requirements and outcomes to applicants, including all rules and regulations, his/her rights and responsibilities, available benefit dates, reason for approval or denial and the right to appeal. 
• Interface daily with statewide computer system requiring accurate and complete data entry of information. Interprets and evaluates computer generated data to determine application to individual case processing for approvals, changes, denials, and discontinuations. 
• Utilizes computer daily for inquiry and data entry for preparation of complex correspondence, spreadsheet development and record maintenance and research. Maintain client records within the Colorado Benefit Management System (CBMS) and electronic case file in the Department's electronic document management system. Document all actions taken on applications and cases within CBMS. 
• Completes monthly reports that are instrumental in discovering discrepancies that could affect participant's eligibility. 
• Participates along with supervisor in the dispute resolution process with applicants/participants when requested. Prepares evidence, attends, and testifies in state level hearings on applicant/participant appeals.  
• Performs other related duties and responsibilities as required. 

Supplemental information

 Experience: This position requires at least one year experience in an office/clerical setting or with extensive public contact. Prior experience determining eligibility for Medicaid preferred. 
 
 Education and Training:
 High School Diploma or GED equivalent. Satisfactory completion of an associate or bachelor’s degree in business, behavioral science, or another appropriately related field may substitute for experience on a year for year basis. 

 License or Certificate: None. 
 
 Background Check: Must pass a criminal background check.

This position may require additional background or health requirements as determined by the contracted community partner. (For example, TB testing or a requirement for vaccination.)

 Other: 
 Bilingual applicants are preferred.

Ability to work in a standard office environment. 

 Ability to obtain, maintain, and ensure continued access to State and County systems in strict compliance with all applicable county and state regulations, policies, and user agreements.

This position is Project Designated. A Project Designated position is a temporary appointment, not a regular full-time role. This project may l