This position is located in the Department of Health Care Finance (DHCF), Health Care Policy and Research Administration’s (HCPRA) Medicaid Branch (MB). The mission of DHCF is to improve the health outcomes of low-income residents of the District by providing access to a full range of preventative, primary, urgent and critical health care services. The MB is responsible for determining eligibility for Medical Assistance programs in the District of Columbia.

This incumbent serves as a Social Service Representative responsible for determining eligibility and enrolling customers in Medical Assistance programs in the District of Columbia.

DUTIES AND RESPONSIBILITIES

Applies policies and procedures while reviewing applications, renewals/recertifications, reported changes, and other sources of information from DHCF customers in order to determine eligibility for Medicaid (MAGI or Non-MAGI), taking action to authorize, revise, continue, or discontinue financial assistance and other services. Utilize eligibility systems and other sources of electronic ad paper information in order to look up case history, understand current eligibility, and identify any required actions from the customer or DHCF. Interviews customers in person and by telephone in order to collect information and evidence required for eligibility determinations. Provides high-quality customer service by listening respectfully and responding appropriately, empathizing with the customer in order to identify and document barriers.

Leverages available information while taking appropriate action in order to resolve questions and issues, reducing the need for additional interactions. Responsible for testifying and defending DHCF action and policy in fair hearings, administrative hearings, and court sanctions. Coaches and assists less experienced SSRs in order to help improve their accuracy, timeliness, and productivity in performing duties. May serve as a Team Lead on special projects, providing direction to other SSRs, as directed. Captures detailed case notes using templates and protocols for future reference by authorized staff while adhering to privacy and security guidelines with all paper and electronic information.

QUALIFICATION AND EDUCATION

Specialized Experience: Specialized experience is experience which is directly related to the position and has equipped the individual with the knowledge, skills, and abilities to successfully perform the duties of the position. To be creditable, at least one (1) year of specialized experience must have been equivalent to at least the next lower grade level in the normal line of progression.

LICENSES AND CERTIFICATIONS

None

WORKING CONDITIONS/ENVIRONMENT

The work is performed in an office setting and sedentary in nature.

OTHER SIGNIFICANT FACTS

Tour of Duty: 8:15 am – 4:45 pm (Monday thru Friday)

Pay Plan, Series and Grade: CS-0187-11

Promotion Potential: No known promotion potential

Collective Bargaining: This position is covered under a collective bargaining unit, American Federation of State, County and Municipal Employees (AFSCME), Local 2401, and subject to union dues thru payroll deduction.

Position Designation: This position has been deemed security sensitive. Accordingly, the incumbent will be subject to pre-employment checks (criminal background, consumer credit check, traffic record check and drug testing, if applicable) as a condition of employment, and will be subject to periodic criminal background checks for the duration of tenure.

EEO Statement: The District of Columbia Government is an Equal Opportunity Employer. All qualified candidates will receive consideration without regard to race, color, religion, national origin, sex, age, marital status, personal appearance, sexual orientation, family responsibilities, matriculation, physical handicap, or political affiliation.

Dept of Health Care Finance

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