Eligibility Workers are responsible for the initial and ongoing eligibility and issuance of benefits for financial assistance programs and services. The Eligibility Worker communicates program requirements, assists in understanding eligibility, provides education, makes referrals to other community resources and ensures the integrity of the financial assistance programs and services.

ESSENTIAL DUTIES AND RESPONSIBILITIES INCLUDE THE FOLLOWING. OTHER RESPONSIBILITIES AND DUTIES MAY BE ASSIGNED.

Administer Eligibility Determination for Federal and State Public Assistance. (Priority A, % of Time 45%, Discretion A)

• Conducts complex case evaluations and extensive personal interviews with clients for purpose of assessing eligibility.
• Determines eligibility, and recertification, of benefits for financial assistance programs in accordance to federal, state and local laws, policies and procedures.

Provide ongoing case management. (Priority A, % of Time 45%, Discretion A)

• Maintains complete and accurate records on client’s eligibility for all assigned programs to meet state and federal requirements of Department of Human Services Quality Control and Program Compliance Audits. 
• Communicates client changes that are considered vital to appropriate staff.
• Informs clients of eligibility status, refers to programs and other community resources, guide to self-support.
• Composes correspondence and constructs reports.
• Resolve Income Eligibility Verification System, PARIS, and New Hire Matches timely. Adjust Benefit amount or close the case. 
• Authorize, educate, and enforce the county healthcare access plan. 
• Assists clients in resolving health plan problems, investigating issues and providing resolution. 
• Impose sanctions or disqualification for clients out of compliance.

Determine Cost Effective Insurance by analyzing Health Insurance policies.

• Determine eligibility for monthly Medicare premium reimbursement. 
• Authorize payments to reimburse the client. 

Prepare and participate in Appeal Hearings and complete case action as needed.

• Prepares testimony, case documentation, financial calculation and exhibits for hearings. 
• Review complex situations with county attorney. 
• Testify to appeals judge on policy and procedures. 

Identify potential fraud, provide data and information to Law Enforcement and County Attorney’s Office, and prepare cases for administrative disqualification or prosecution. 

Recreate budget to determine overpayments and authorize recoupment of funds. 

Administrative Duties (Priority A, % of Time 10%, Discretion A)

• Clarify and explain information on financial programs to other agency staff, County Board, clients, potential clients, attorneys, authorized representatives.
• Represent agency at request of agency Director or County Board.
• Research and interpret policies and regulations established by legislative statutes and MN Department of Human Services Rules for the purpose of determining eligibility programs.
• Participate in professional staff development, training sessions and meetings to remain current regarding legislative, policy, and procedure changes in financial assistance program requirements. 
• Provide excellent customer service. 
• Other duties as assigned.

To perform this job successfully, an individual must be able to perform each essential duty. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Education and/or Experience: Two years of study from an accredited two- or four-year college with emphasis in behavioral science, business or closely related subjects; or two years of clerical experience in a social services/human services agency; or three years of clerical experience and/or experience working with the public; or a Technical College Human Services Eligibility Worker Diploma; or equivalent combination of education and experience.