Job Specification Details

Professional and technical health care eligibility, data entry and clerical work performed in a matrixed Health Access Eligibility and Enrollment Unit for Vermont Health Connect and Green Mountain Care. These positions determine applicant eligibility for Vermont's health care programs: Medicaid, Dr. Dynosaur, Healthy Vermonters, VPHARM and Vermont Health Connect. This position is responsible for processing applications, change of circumstances, verifications, terminations and other clerical work using the following systems: Siebel, ACCESS and the Vermont Health Connect portal. A large portion of the work required for this position relies upon the employee's ability to use their independent judgement to make a determination based on complicated policy and rules research. Work is performed under the supervision of a Healthcare Services Supervisor and the Unit's Assistant Director.

Incumbents of this job class will experience fluctuations in assigned duties in response to the organization's needs, program changes, special project needs and changes in experience levels.

Reviews and enters applications for Vermont's health care programs to determine eligibility and complete enrollment and plan selection. Processes change of circumstances/change of information with extreme attention to detail to ensure accurate processing. Customer interaction will be limited but some customer outreach may be conducted regarding status of application and required information needed to complete the process. Requires a thorough understanding of internal and external business processes and assist in determination of the correct path of escalation for a case, in addition to a thorough understanding of policies and guidelines for multiple federal healthcare policies. Ability to navigate through and interpret data from various systems such as Siebel, ACCESS, OnBase and Benaissance in order to extract necessary information and history of a particular case.

VT Healthcare Service Specialists will be enrolling clients in Dr. Dynosaur, Dr. Dynosaur for pregnant women, VPHARM for prescription coverage, Blind-Aging-Disabled Medicaid, Vermont Health Connect, Immigration Medicaid, Transitional Medicaid, Working People with Disabilities, and Assisted Community Care Services. All enrollments must be done in a timely manner in order for customers to receive services. Administrative case management duties such as: ensuring information is accurate according to document protocols, processing of return mail, pharmacy applications, quarterly reports, and verifications and sending out mailings is also a critical component of the job.

Duties are performed in an office setting. Workload is consistently heavy with constant need for prompt and accurate data enter and decision making. Incumbents must be able to function independently, prioritize their own work and multi-task effectively. Private means of transportation should be available for necessary travel to training and/or meetings. Applicants may provide a variety of challenges including but not limited to highly emotional conditions (i.e. inability to communicate, attempts at falsification, unhappy customers). Work outside of typical business hours may be expected.

Knowledge of an ability to apply computer skills such as database management, CRM (customer Relationship management) software utilization and Microsoft Office programs.

Must have the ability to research and use independent judgement to make a determination or choose correct escalation path.

Ability to stay organized and work effectively independently and in a team setting.

Must be able to comprehend the varying levels of priorities between cases and escalate based on medical and/or benefits results.

Ability to communicate in a professional manner with both internal and external customers

Ability to explain complex instructions, regulations, and policies in a clear and easy-to-understand way.

Effective keyboarding skills which will enable processing of large volumes of applications and other documents in a timely manner.

Working with and communicating to culturally diverse groups and accommodating their different needs and viewpoints.

Ability to process large volumes of work accurately while under strict time constraints.

Working knowledge of healthcare programs and basic philosophy underlying each is a plus.

Ability to read, interpret and apply complex rules, regulations, policies and procedures.

Ability to multi-task under strict time restraints.

Ability and skill in arithmetic computation.

Ability to communicate effectively verbally and in writing.

Human Services: customer service, holistic service, strengths-based relationships, and results orientation.

No education or experience required. 
 

Experience in a customer service or call center environment. Ability to use computer programs or experience with data entry, or the ability to explain policies/procedures or rules/regulations

Candidates must pass any level of background investigation applicable to the position. In accordance with AHS Policy 4.02, Hiring Standards, Vermont and/or national criminal record checks, as well as DMV and adult and child abuse registry checks, as appropriate to the position under recruitment, will be conducted on candidates, with the exception of those who are current classified state employees seeking transfer, promotion or demotion into an AHS classified position or are persons exercising re-employment (RIF) rights.