Eligibility Specialist III (Medicaid QA/Training)

The Department of Social Services is seeking a highly motivated, dependable professional with advanced communication and exceptional customer service skills to determine eligibility for various State programs. The successful candidate must be able to interpret complex rules and regulations and use good judgment to make appropriate eligibility decisions. They must have exceptional organizational skills, the ability to perform basic mathematical calculations, the ability to work quickly within deadlines, have basic knowledge of universal computer technology and general office equipment, and be able to thrive in a team-oriented environment. This position serves as an Eligibility Specialist for Long Term Care (LTC), Community Alternatives Program for Disabled Adults (CAP), and Program of All-Inclusive Care for the Elderly(PACE) (Medicaid Services/Adult Medicaid) Prefer two years' experience as an Eligibility Specialist. Medicaid Division/Adult Medicaid 

The Eligibility Specialist Trainer for the North Carolina Medicaid program is responsible for training both new and experienced Eligibility Specialist staff in Medicaid policies and procedures, including related programs such as Non-Emergency Medical Transportation (NEMT) and operations of the Medicaid Call Center. The trainer will conduct audits of eligibility specialist records to ensure compliance with accurate Medicaid eligibility determinations based on all applicable policies and internal control activities, with proper documentation. A key part of the role includes completing and submitting the DHB-7078 and/or other second-party review and tracking forms, identifying trends in errors, and developing targeted training to address those issues.

• Individual must support the Forsyth County Guiding Principles of WeCare: Integrity, Awareness, Accountability, Respect and Excellence
• This position calls for the ability to work in a fast-paced, continuously evolving office environment
• The ability to communicate with internal and external customers from diverse backgrounds
• Work onsite Monday- Friday from 8:00 AM to 5:00 PM

Graduation from high school or GED. 

A higher education level may be considered as a substitution for all or part of the experience requirement.  

Two years of experience preferred as an Eligibility Specialist with knowledge of public assistance programs as well as a concentration in two or more programs which includes: Family & Children Medicaid, Adult Medicaid including Private Living, Long- Term Care, special Assistance, Non- Emergency Medicaid Transportation as well as a strong knowledge of NCFAST partnered with an ability to analyze data, develop curriculum, schedules, and the capability to provide training in a virtual setting.

• The ideal candidate will have a thorough understanding of the North Carolina Medicaid program and a good working knowledge of other agency and community services that may impact clients.

• A general understanding of all economic services programs is also preferred. Strong mathematical, analytical, and computer skills are essential, along with the ability to interpret complex regulations and work independently while managing multiple priorities.

• The candidate should have experience in evaluating staff performance, training others in policy and procedures, mentoring team members, and adapting to a fast-paced, high-volume work environment with flexibility and initiative.

• A strong team-player mentality is essential, along with the ability to foster a collaborative training environment.

• The person in this role must be highly adaptable and able to adjust to shifting job demands as needed.

• Proficiency in NC FAST, electronic document imaging, and accurate data entry is required.

• This is an on-site position with regular work hours Monday through Friday, 8:00 a.m. to 5:00 p.m.

• The trainer will also perform routine eligibility functions such as keying applications, approving, denying, or withdrawing cases, conducting redeterminations, and managing changes in circumstances.

• This includes using systems such as NC FAST and the systems captured within, including DMV, SSA, ESC, ACTS, and DOC, to conduct eligibility checks and updates.

• The position requires strong customer service and interviewing skills, and the trainer will be responsible for conducting training in these areas as well.

• Additionally, the role includes developing and updating training tools and materials to reflect current policy and procedure changes.

• In the absence of assigned staff, the trainer may fill in to complete casework or application processing.

• The Eligibility Specialist Trainer will provide feedback to the supervisor regarding the skills and competencies of Medicaid staff and may also provide training based on internal and external audit findings.

• The trainer will serve at times as a lead worker by managing work demands, as well as filling in for the supervisor when required.

• The position also involves monitoring program reports to ensure timely completion and compliance with agency standards.

Salary : $42,952 - $49,400