POSITION PURPOSE: The Eligibility Specialist is responsible for coordinates and monitors participants benefits, which includes gathering information necessary for the determination of Medicaid and Social Security benefits.

WORK CONDUCT:

1. Maintains a positive and enthusiastic attitude.
2. Works harmoniously and effectively with staff and the public.
3. Arrives to work on time.
4. Keeps work space clean and organized
5. Stays awake and alert while on work time.
6. Works a flexible schedule including evenings and weekends as assigned.
7. Works the full hours per week for the position.
8. Effectively works under stressful situations with problem customers.

ESSENTIAL FUNCTIONS:

1. Maintain an encouraging and enthusiastic attitude; requires an absolute commitment to creating and sustaining a positive work environment.
2. Position requires excellent communication and interpersonal skills with internal and external audiences.
3. Recurring tasks will include (but are in no way limited to):

1. Monitors, schedules, and follows up on participant appointments pertaining to benefits
   1. Works with appropriate staff in gathering necessary information for Social Security and/or Medicaid appointments
   2. Monitors the benefit status of each participant.
   3. Communicates with appropriate agencies regarding participants’ health.
   4. Travels with and/or without participants to social security offices in Northwest Indiana (Lake, LaPorte and Porter counties)
   5. Monthly check of Medicaid eligibility.
2. Acts as the liaison/resource for all community referrals by helping participants and families obtain appropriate entitlements
3. Responsible for case coordination
   1. Monitors participants finances
4. Gathers information for all participant ID’s, burial trust, Arc trust, etc.
5. Coordinates with medical offices on Medicare plans for non-covered medication.
6. Collaborates with the account department in monitoring participant entitlements including Medicaid, Medicare, SSI, etc.
7. Provides assistant to participants in handling any information regarding their residence
   1. Verify income for tenants
   2. Complete maintenance orders, invoices, and follow up to ensure safety of tenants and property
   3. Maintain proper documentation for annual income guidelines.
   4. Handle apartment inquires

1. Maintains up-to-date records, reports and communicate a monthly balance of bank account and/or ARC account to appropriate personnel (program managers, guardians, case managers etc.).
2. Communicates eligibility status, suspension of benefits and/or re-establishment of benefits with appropriate personnel.
3. Maintain accurate records of participants (birth certificate, guardianship documentation, SS card, Medicaid card, lease, etc.).
4. Open ARC account when necessary.

1. May work hours outside the general office hours7:30 - 4:00 operation time frame.
2. Follows all agency policies and procedures.
3. Provide resources and assist participants and significant other, as needed to access community resources.
4. Attend meetings, in- services and professional development activities, as necessary
5. May be asked to serve as the agency liaison for various committees
6. Follows all agency policies and procedures regarding the use and release of confidential information and confidential PHI (protected health information).
7. Adheres to all agency policies and procedures regarding ethics, client rights and dignity of persons served.
8. Adheres to all health & safety regulations; uses protective equipment as necessary.

While this covers a number of essential functions of the job, it is not all-encompassing

nor a comprehensive listing of activities, duties or responsibilities of this role. There are additional functions not specifically listed, and the duties, responsibilities and activities of this role may change at any time with or without notice.

ADDITIONAL RESPONSIBILITES:

• Other tasks as directed

KNOWLEDGE, SKILLS, AND EDCAUTION:

• High school diploma or equivalent required, bachelors degree preferred.
• 1-2 years’ experience of data entry, record keeping or similar experience in the Human Services field.
• Knowledge of Medicaid/Medicare, state eligibility verification and authorization management.
• Intermediate to advanced computer skills, including the use of Microsoft Office applications (e.g. Word, Excel) and knowledge Analytic and persistent; able to get to the root of problems.
• Must be able to handle routine questions and direct contacts and calls to appropriate staff member(s).

COMMUNICATION SKILLS:

• Demonstrates excellent communication and customer service skills under duress and in a fast pace; ability to function as a positive team member.
• Must communicate in a professional manner with employees of Paladin as well as external contacts and agencies.

PHYSICAL REQUIREMENTS:

• Ability to sit for long periods of time and use a pc keyboard.
• Standing while filing in front of various size file drawer cabinets. Requires some

bending to reach lower file drawers.

• Speaking, hearing, and/or visual ability to communicate.
• Walking
• Reasonable accommodations may be made to enable individuals with disabilities to perform essential functions.

MENTAL REQUIREMENTS:

• Patience and diplomacy needed when dealing with clients or public with limited communication skills or difficult clients.
• Work under pressure to meet deadlines
• Ability to work on several tasks at same time such as (typing, answering telephone, answering questions).
• Work with minimum supervision (makes own decisions as to priorities).
• Work as member of team to meet deadlines

TOOLS AND EQUIPMENT:

• Operates office equipment: computer, copy machine, postage machine/scale, two-way radio, and telephone system.

ADDITIONAL INFORMATION:

• Must have knowledge of global agency operations in order to answer questions and direct individuals appropriately.
• May be required to change work schedule to meet deadlines during special events, such as fund-raising events, client events or special, pre-arranged deadlines.