What Success Looks Like In This Job

This position determines eligibility for Health First Colorado (formerly Medicaid), including Long Term Care and CHP .

Examples of Duties for Success

• 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 [AMA1] 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.

Qualifications for Success

To be successful, our ideal candidate should have the following knowledge, skills, and abilities

• Knowledge of medical public assistance programs, as applicable.
• Knowledge of CBMS.
• Apply basic math and read, interpret, and apply rules and regulations.
• Communicates clearly and concisely, both orally and in writing.
• Differentiate between relevant and non-relevant information when making eligibility decisions.
• Input data accurately and detect errors/make corrections.
• Skills related to customer service.
• Ability to establish, maintain, and foster positive and harmonious working relationships with those contacted in the course of work.

More Qualifications for Success

The Medicaid Specialist is responsible for processing Medicaid benefits.
Experience: This position requires at least one year experience in an office/clerical setting or with extensive public contact. Prior experience determining eligibility for CBMS 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.

• Bilingual applicants are preferred.
• Ability to work in a standard office environment.