SPECIAL PROGRAMS ELIGIBILITY SPECIALIST - 09292026- 81171

State of Tennessee Job Information

Qualifications

• Education and Experience: Graduation from an accredited college or university with a bachelor's degree or graduation from an accredited college or university with an associate's degree and two years of qualifying professional experience related to administrative, customer service and/or data entry positions associated with the application of policy or executing procedural provisions and/or eligibility within a health or healthcare, casework, or an insurance setting.
• Substitution of Experience for Education: Qualifying professional experience related to administrative, customer service and/or data entry positions associated with the application of policy or executing procedural provisions and/or eligibility within a health or healthcare, casework, or an insurance setting may substitute for the required education to a maximum of four years (e.g., experience equivalent to one year of full-time work in one or a combination of the above listed fields may substitute for one year of the required education).
• Substitution of Experience for Education: Two years of full-time work as a Managed Care Specialist with the State of Tennessee.

Necessary Special Qualifications

• A valid motor vehicle operator's license may be required.

Overview

Responsibilities

• Determining Eligibility:
• Responsible for reviewing individual applicant applications (i.e.: Breast and Cervical Cancer, Former Foster Care, Children leaving Foster Care, and Emergency Medical Services and enrollee income, resources and other technical elements
• Register applications as needed
• Process Special Programs related eligibility tasks. This includes priority task from DCS i.e.: Children entering foster care
• Monitor queues and production
• Process reports to maintain accurate member caseloads
• Trouble shoot and respond to inquiries regarding member eligibility.
• Demonstrate strong customer service skills, interpretation of public policy, and problem solving
• Use proprietary computer-based systems to perform work duties
• Respond to emails, telephone calls, and other correspondence in a timely fashion
• Customer Service/Time Management
• Work in a systemic manner in partnership with vendor staff, internal customers, and external stakeholders to provide services and support to a shared client base. This will require verbal and/or electronic communications with the vendor, internal customers and outside organizations and stakeholders to obtain or share information regarding applicant/enrollee circumstances regarding eligibility and to solve eligibility related issues
• Be adept at dealing with ambiguity
• Manage time and attendance
• Prioritize tasks
• Make corrections on cases that have identified errors and perform case reviews as needed to provide additional to management and other stakeholders
• Request guidance and/or training in areas of uncertainty or knowledge deficiency and participate in required training
• Exercise professional judgment to know when to escalate a concern or issue
• Communication
• Remain up to date on new policies and procedures as they are implemented in order to ensure accurate eligibility determination.
• Attend Staff meetings with peers and one on one meetings with superiors
• Ensure accurate and clear communications
• Explain eligibility for benefits and services
• Interpret policy and procedure in relation to the enrollee's circumstances to ensure the member or applicant's understanding
• Communicate the enrollee/applicant's responsibilities to the enrollee/applicant in a way that is easily understood and ensure the enrollee/applicant's understanding.

Competencies (KSA's)

Knowledge

Skills

• Active Learning and Listening
• Complex Problem Solving
• Judgment and Decision Making
• Monitoring
• Time Management

Abilities

Tools & Equipment