Eligibility Specialist

Posting number: 1473

Department: Health Benefits Exchange

Job classification: WHBE000

Posting type: Open

Categories: Public Health

Summary

The mission of Washington Health Benefit Exchange (Exchange) is to radically improve how Washington residents secure health insurance through innovative and practical solutions, an easy-to-use customer experience, our values of integrity, respect, equity and transparency, and by providing undeniable value to the health care community.

The Exchange is a public-private partnership that operates Washington Healthplanfinder, the eligibility and enrollment portal used by one in four Washington residents to obtain health and dental coverage. Through this platform, and with support from a Customer Support Center and statewide network of in-person navigators and brokers, individuals and families can shop, compare and enroll in private, qualified health plans (as defined in the Affordable Care Act) or enroll in Washington Apple Health, the state Medicaid program.

The Exchange embraces the following equity statement adopted by our Board of Directors:

Equity is fundamental to the mission of the Washington Health Benefit Exchange. The process of advancing toward equity and becoming anti-racist is disruptive and demands vigilance to dismantle deeply entrenched systems of privilege and oppression. While systemic racism is a root cause of many societal inequities, we must also use an intersectional approach to address all forms of bias and oppression, which interact with and often exacerbate racial inequities. To be successful, we must recognize the socioeconomic drivers of health and focus on people and places where needs are greatest. As we listen to community, we must hold ourselves accountable to responding to recommendations to remedy inequitable policies, systems, or practices within the Exchange’s area of influence. Our goal is that all Washingtonians have full and equal access to opportunities, power and resources to achieve their full potential.

SUMMARY
The Washington Health Benefit Exchange (Exchange) receives thousands of applications for health insurance coverage each day via Washington Healthplanfinder. Using facts, discretion, and independent judgment, this position makes qualitative decisions regarding legal and regulatory compliance with the Affordable Care Act (ACA) by determining coverage and/or subsidy eligibility for customers who applied for health insurance through Healthplanfinder. This includes reviewing documentation to verify citizenship, lawful presence, tribal enrollment, incarceration status, social security number, eligibility for other minimum essential coverage (MEC), and income attestations(s). The incumbent must determine the customer's eligibility for tax credits and/or enrollment in a qualified health or dental plan in accordance with the ACA, regulations, laws, policies, and established business processes. In addition, the incumbent will be expected to actively participate in quality assurance checks of eligibility rules, policies, guidance, and processes in our efforts to achieve continuous improvement.

Examples of duties

•Working knowledge of the Affordable Care Act, Medicaid, the commercial health insurance market, and Federal and State subsidy programs.
•Maintain a working knowledge and understanding of conditional eligibility verification regulations, laws, policies and guidance, and operation of the prescribed computer programs. 
•Use and manage multiple complex computer systems and databases simultaneously to make accurate determinations regarding the customer’s lawful presence or citizenship status, income, social security number, incarceration status, tribal enrollment, and access to other, minimum essential coverage. 
•Explain complex requirements and federally mandated timelines to customers who have minimal understanding of the ACA, the health insurance landscape, and/or may have limited English language proficiency. 
•Validate and reconcile customer-supplied documents against customer attestation. 
•Determine whether customer-supplied documentation is acceptable or fails to enable verification of eligibility and send written correspondence to customers notify them of the determination. 
•Adhere to changes in Federal regulations, state law,