Eligibility Specialist II

The Department of Social Services is seeking a highly motivated, dependable professional to serve as an Eligibility Specialist II in the Medicaid Services Division. This position is responsible for determining eligibility for a variety of North Carolina Medicaid programs and requires exceptional customer service skills, advanced communication abilities, and the capacity to work effectively with a diverse population.

The successful candidate must be able to interpret and apply complex county, state, and federal policies and regulations, using sound judgment to make accurate and appropriate eligibility determinations. Responsibilities include obtaining, verifying, and evaluating detailed information related to family composition, financial resources, employment, and other pertinent data. The specialist must provide empathetic and clear explanations of program requirements based on mandated policies and utilize agency procedural guides to ensure compliance with all Federal and State regulations.

Strong organizational skills, good mathematical reasoning and computational ability, and proficiency in basic mathematical calculations are essential. Candidates must also possess knowledge of general office equipment and universal computer technology and be able to work efficiently under strict deadlines in a fast-paced, team-oriented environment.

Skills

The successful candidate will be able to interpret complex rules and regulations and use sound judgment to make appropriate eligibility determinations. They will also possess the following knowledge, skills, and abilities:

• Basic knowledge of universal computer technology, standard office procedures, practices, and equipment.
• Skill in operating a variety of office machines, computers, and applicable software, with the ability to type 40 words per minute or faster.
• Exceptional organizational skills and the ability to prioritize work effectively within structured time frames and deadlines.
• Exceptional customer service skills and the ability to communicate clearly and effectively, both orally and in writing, with individuals from diverse social, economic, cultural, and educational backgrounds.
• Considerable knowledge of and ability to read, analyze, interpret, and apply federal, state, and county program rules, regulations, and procedures.
• Ability to work effectively in any assigned line staff position, including all eligibility programs and functions.
• Ability to understand and follow oral and written instructions and establish and follow detailed work procedures.
• Ability to perform casework, mathematical reasoning, and computations with speed and accuracy.
• Ability to prepare and maintain accurate records and reports.
• Ability to thrive in a team-oriented environment while maintaining composure and keeping emotions in check, even in difficult or stressful situations.
• Ability to maintain regular and reliable attendance.
• Ability to establish and maintain effective working relationships with colleagues, community partners, and the general public.
  
  

The individual must support the Forsyth County Guiding Principles of WeCare:

Integrity, Awareness, Accountability, Respect, and Excellence.

Graduation from high school or GED and three years of paraprofessional, clerical or other public contact experience which may include negotiating, interviewing, explaining information, gathering and compiling data, analyzing data and/or the performance of mathematical or legal tasks.

One year of experience in an income maintenance program may substitute for two of the three years of relevant experience.

An equivalent combination of education and experience may be considered for minimum qualification requirements.

Previous NCFAST Experience Preferred.

Advanced communication skills and customer service experience are preferred.

Bilingual skills (English/Spanish) are a plus.

The preferred candidate possesses a minimum of 1 year experience in Program and 1 year experience in NCFAST.

• Will consider the following qualifications as a work-against**
  
  

Graduation from an accredited associate degree program in Human Services Technology, Social Services Associate, Paralegal Technology, Business Administration, Secretarial Science or a closely related curriculum; or graduation from high school and two years of paraprofessional, clerical, or other public contact experience which included negotiating, interviewing, explaining information, gathering and compiling of data, analysis of data and/or performance of mathematical or legal tasks with at least one year of such experience being in an income maintenance program; or graduation from high school and three years of paraprofessional, clerical or other public contact experience which included negotiation, interviewing, explaining information, the gathering and compiling of data, the analysis of data and/or the performance of mathematical or legal tasks; or an equivalent combination of training and experience.

• Gathers and reviews household income, financial resources, and residency information; computes budgets as required.
• Reviews forms and other application documents; verifies information through telephone calls and written correspondence with local government agencies, employers, attorneys, representatives, and other relevant contacts.
• Explains program requirements and options to applicants; advises or refers clients to other programs or services as appropriate.
• Informs clients of their rights and obligations as prescribed by program policies.
• Responds to inquiries from clients and the general public regarding benefits, the application process, and program eligibility; provides information and assistance as needed.
• Computes and authorizes benefit amounts for assigned programs.
• Navigates various complex computer systems to enter and retrieve data from applicable state and county systems.
• Documents all actions and case information in the electronic case record.
• Operates computers, scanners, calculators, and other standard office equipment used to maintain records.
• Participates in ongoing training as required.
• Participates in teams, committees, job fairs, off-site application events, and outreach activities as assigned.
• Performs related duties as required.
• Assists with vacant caseloads as backup when needed.
• Interviews clients to obtain required information.
• Interacts daily with internal and external customers in person, by phone, virtually, and via email.
• Explains program requirements; completes initial applications; verifies information obtained from clients; and determines program eligibility.
• The role requires extensive daily use of a computer and various systems to determine Medicaid eligibility.
  
  

These duties are intended only as illustrations of the various types of work performed. The omission of specific duties does not exclude them from the position if the work is similar, related, or a logical assignment to the position.

This is an onsite position, Monday through Friday, 8:00 AM to 5:00 PM, in an office setting. The role requires extensive daily use of a computer and associated systems to determine Medicaid eligibility, as well as regular interaction with internal and external customers through multiple communication methods.