MassHealth is seeking a dynamic customer service-focused individual to be part of the Benefit and Eligibility team by conducting eligibility assessments for long-term and other medical services for the elderly and people with disabilities. This position entails excellent communication skills as the candidate will be required to communicate and respond to customers, applicants, attorneys, estate planners, advocates, public officials, and external agencies promptly. The Benefits and Eligibility Specialist must represent the agency at hearings by preparing and delivering explanations of complex eligibility determinations, demonstrating a high level of professionalism, and using exceptional interpersonal skills.
The incumbent will also be responsible for performing complex calculations to determine income and asset allowances accurately. The Benefits and Eligibility Specialist will possess advanced financial analysis skills, including the ability to review and interpret complex financial documents such as taxes, trusts, income levels, properties, assets, annuities, securities, insurance information, and medical records.
Duties and Responsibilities (these duties are a general summary and not all inclusive):
- Evaluate eligibility of MassHealth coverage for elders and long-term care recipients, by examining financial documents, income level, properties, assets, liabilities, trusts, annuities, securities, insurance information, and medical records, and applying program criteria.
- Facilitate the accurate and timely determination of initial eligibility by communicating program requirements to customers and follow-up.
- Explain programmatic requirements including transfer of asset rules, estate and property guidelines, evaluation of income and assets from trusts, retention of spousal income and assets, and alternative methods to validate reported information.
- Appraise the value, ownership, relationship and accessibility of assets and income to determine the conditions of eligibility based on program rules, such as liens, penalty and disqualification periods.
- Calculate income allowance and assess the ability to retain excess assets in spousal situations.
- Determine eligibility status (approved, denied, or pending) based on standard criteria within prescribed timeframes, by identifying assets, performing income and asset calculations, and approving deductions.
- Enter applicant data into agency computer system to establish and update customer data, validate data, and make corrections as needed.
- Confirm customer demographic, financial, and background data by contacting the applicant, collateral sources, and reviewing immigrant documentation to determine status.
- Represent the agency at hearings by preparing and delivering explanations of eligibility determinations.
- Provide requested services and make appropriate referrals for customers to external programs for which they may qualify.
- Complete and send notices as appropriate based on eligibility determination, evaluate medical bills to determine whether income and/or asset deductions are met.
- Perform a variety of agency tasks/projects such as maintaining and updating policy and procedures manuals, attending staff meetings and training sessions, and completing workaround projects in accordance with agency directives.
Preferred Qualifications:
- Proven experience working with individuals from diverse backgrounds, including those with disabilities, geriatric populations, non-English speakers, and low-income families.
- Demonstrated ability to work independently and as part of a team.
- Experience in eligibility determination for Medicaid or other public benefits programs.
- Knowledge of medical terminology, diagnosis codes, and billing practices.
- Ability to communicate effectively with customers, coworkers, and external stakeholders, both orally and in writing.
- Strong analytical and problem-solving skills, with attention to detail.
- Demonstrated ability to work independently, manage time effectively, and meet deadlines.
- Ability to maintain confidentiality and handle sensitive information in a professional manner.
- Proficient in Microsoft Office applications, including Word and Outlook.
About MassHealth:
To improve the health outcomes of our diverse members and their families by providing access to integrated health care services that sustainable & equitable health, well-being, independence, and quality of life.
For more information about our agency and programs please visit: www.mass.gov/masshealth
Pre-Offer Process:
A criminal background check will be completed on the recommended candidate as required by the regulations set forth by the Executive Office of Health and Human Services prior to the candidate being hired. For more information, please visit http://www.mass.gov/hhs/cori
Education, licensure and certifications will be verified in accordance with the Human Resources Division’s Hiring Guidelines.
Education and license/certification information provided by the selected candidate(s) is subject to the Massachusetts Public Records Law and may be published on the Commonwealth’s website.
If you require assistance with the application/interview process and would like to request an ADA accommodation, please click on the link and complete the ADA Reasonable Accommodation Request Form.
For questions, please the contact the Office of Human Resources at 1-800-510-4122 and select option #4.
TO APPLY:
Please upload both Resume and Cover Letter for this position when applying.
Qualifications
First consideration will be given to those applicants that apply within the first 14 days.
MINIMUM ENTRANCE REQUIREMENTS:
At least four years of full-time, or equivalent part-time, professional experience in social work or social casework, claims adjudication, job placement, recruitment, employment counseling, vocational or rehabilitation counseling, credit investigation, educational counseling, legal advocacy, or legal counseling.
SUBSTITUTIONS:
- A Bachelor's or higher degree may be substituted for two years of the required experience on the basis of two years of education for one year of experience.
- One year of education equals 30 semester hours. Education toward a degree will be prorated on the basis of the proportion of the requirements actually completed.
LICENSES: Based on assignment, travel may be required. Those employees who elect to use a motor vehicle for travel must have a current and valid Massachusetts Motor Vehicle Operator's license or the equivalent from another state.
Comprehensive Benefits
When you embark on a career with the Commonwealth, you are offered an outstanding suite of employee benefits that add to the overall value of your compensation package. We take pride in providing a work experience that supports you, your loved ones, and your future.
Want the specifics? Explore our Employee Benefits and Rewards!
An Equal Opportunity / Affirmative Action Employer. Females, minorities, veterans, and persons with disabilities are strongly encouraged to apply.
The Commonwealth is an Equal Opportunity Employer and does not discriminate on the basis of race, religion, color, sex, gender identity or expression, sexual orientation, age, disability, national origin, veteran status, or any other basis covered by appropriate law. Research suggests that qualified women, Black, Indigenous, and Persons of Color (BIPOC) may self-select out of opportunities if they don't meet 100% of the job requirements. We encourage individuals who believe they have the skills necessary to thrive to apply for this role.
Official Title: Benef Elig & Refer Soc Wrk (C)
Primary Location: United States-Massachusetts-Taunton-21 Spring Street
Job: Community and Social Services
Agency: Exec Office Of Health and Human Services
Schedule: Full-time
Shift: Day
Job Posting: Jan 29, 2024, 8:42:59 AM
Number of Openings: 1
Salary: 65,974.48 - 89,633.44 Yearly
If you have Diversity, Affirmative Action or Equal Employment Opportunity questions or need a Reasonable Accommodation, please contact Diversity Officer / ADA Coordinator: Diane Randolph-Jones/Diane.Randolph-Jones@mass.gov - 8577570096
Bargaining Unit: 08-SEIU - Local 509 - Social/Rehabilitation
Confidential: No
Potentially Eligible for a Hybrid Work Schedule: Yes