Senior Eligibility Specialist

Union County, North Carolina Monroe, NC
General Statement

Employees in this class are responsible for serving in maintenance roles in a County Department of Social Services. The income maintenance programs involved include Food Stamps, Temporary Assistance to Needy Families (TANF), Medicaid, County Special Assistance, and Subsidy Childcare. Employees serve in one of the following roles: (1) As lead worker over income maintenance caseworkers or as lead worker over a unit of a single program area which performs all functions (i.e., intake, processing, and review). Work may also include performing the same eligibility determination functions as the Income Maintenance Caseworker I and/or II. Employees are required to spend at least 25 percent of their time in a lead worker capacity. (2) Performing a wide range of tasks in the eligibility determination/re-determination process which require an in-depth knowledge of all income maintenance programs and functional processes. Work also involves the resolving of client appeals of actions taken by income maintenance caseworkers, the analysis of program-wide problem areas which include recommendations for corrective action and the training of new and transitional employees for specialized programs (i.e., LIEAP). (3) Functioning with a great deal of independence in a hospital or medical setting with the responsibility for performing a variety of complex tasks and functions in the Medicaid programs which include performing two or more functions in the long-term care programs. Employees assume responsibility for the resolution of complex problems where the consequence of their action can have a considerable effect on the client, the medical institution and/or the agency. Employees are viewed by the medical institution's administrative staff as the primary contact for problem resolution. Employees usually report to a higher level supervisor and review of work at this level is minimal.

Essential Functions

I. DIFFICULTY OF WORK: Complexity - Employees' work involves performing one of the following combinations of duties and responsibilities in the income maintenance program: (1) As lead worker over level II income maintenance caseworkers, employees must be thoroughly familiar with all functional aspects required to properly process the applications of clients applying for benefits. Employees must be knowledgeable enough to advise and counsel lower level staff on policies and regulations of the income maintenance program(s) which affect the more complex cases. Work also requires the provision of training to lower level staff in new program policy directives as well as the completion of second party reviews in the work unit assigned. (2) As a troubleshooter in a large agency, employees' work is characterized by the level of program and procedural knowledge required to work effectively in any line staff position assigned, which includes all income maintenance programs and all functions. Employees act as a hearing officer in resolving client appeals of action taken by income maintenance workers and must be proficient in the analysis of program wide problem areas which include recommendations for corrective action. Work also includes providing training for new and transitional employees. (3) As a hospital/medical setting worker, employees are responsible for determining and/or re-determining client eligibility for the Medicaid programs with particular expertise in the Medicaid long-term care programs. Work also requires the taking and/or processing of client applications for all other income maintenance programs and the provision of technical expertise to hospital administrators and professional staff on issues impacting upon client eligibility for medical assistance as provided by the Medicaid programs.

Guidelines - Employees refer to the Food and Nutrition Services Manual (FNS), Temporary Assistance to Needy Families (TANF [Work First]), Medicaid, Subsidy Childcare and County Special Assistance Manuals in performing functions required to complete the eligibility determination process. Guidelines are subject to periodic and frequent changes. Employees also utilize agency procedural guides in accomplishing the work. Correspondence and memoranda from State regulatory agencies are also used in interpreting policy directives.

II. RESPONSIBILITY: Accountability - Employees' work involves direct contact with the client and direct or indirect contact with the clients' families or representatives and collaterals in order to gather and verify any information necessary to determine clients' eligibility for the program(s). Employees' decisions are usually subject to a third party review. Employees are also responsible for the review of the work of other staff, spotting errors and advising them and management of corrective actions needed to rectify errors. Employees' work at this level is seen as having a greater potential to reflect negatively or positively upon the agency than lower level staff.

Consequence of Action - Employees' decisions impact upon the well-being of the clients who are the recipients of program benefits. The decisions of employees responsible for second party reviews and corrective action plans can be particularly detrimental to the agency if errors are not recognized and if appropriate corrective actions are not taken. Employees working in hospital settings function with a high level of independence. Their decisions can be critical to the continued health of clients and to the appropriate reimbursement of money to medical institutions for services rendered.

Review -Work is reviewed periodically by a first line supervisor usually through a random evaluation of processed cases. The frequency of these reviews will vary from agency to agency. Federal and State guidelines require regional quality reviews which ensure that the procedures and processes used to reach the eligibility decision(s) are correct.

III. INTERPERSONAL COMMUNICATIONS: Subject Matter -Employees provide information to clients on program requirements based upon the information provided in the FNS, Work First, Subsidy Childcare, Medicaid and County Special Assistance Manuals. Employees must be knowledgeable of program policies and processing functions for all of the income maintenance programs. Information contained in these manuals is detailed and must be explained to clients with varying levels of understanding. Employees may be required to explain information regarding a client's status in complex eligibility determination cases to lower level staff.

Purpose -Work with clients includes the gathering of information through the interview process for the purpose of determining applicant/client eligibility as well as to inform the client of their rights and obligations as prescribed under program policies. Work with lower level staff involves training in new policies and the provision of corrective action plans.

IV. WORK ENVIRONMENT: Nature of working Conditions -Employees are frequently subject to working with irate, agitated clients, heavy workloads and compressed time frames.

Nature and Potential of Personal Hazards - Clients may at times be verbally abusive due to their extreme situations or their emotional problems, but generally physical harm is unlikely on an ongoing basis.

Education and Experience

Two years of experience as an Income Maintenance Caseworker; or an equivalent combination of training and experience.

Special Requirements

Knowledge, Skills, and Abilities -Thorough knowledge of income maintenance program assigned. Considerable knowledge of all agency and community programs and services which could affect the client/applicant. General knowledge of all income maintenance programs. Good mathematical reasoning and computational skills. Ability to read, analyze, and interpret a variety of regulations, policies and procedure of varying complexity. Ability to work independently and prioritize work. Ability to instruct arid evaluate the work of lower level employees. Ability to train employees in new and existing rules, regulations, policies and procedures. Ability to understand the needs and problems of clients/applicants. Ability to perform caseworker function under and within structured time frames.

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