Eligibility Determination Worker

About the role

The Texas HIV Medication Program (THMP) seeks an Eligibility Determination Worker to provide support to the Regional Coordinator, collaborate with other program staff, and assist in the planning, development, implementation, and coordination of the daily operations and special projects of the program.

Responsibilities

• Supports the development of eligibility guidelines and screening processes, including applications, forms, and instructions.
• Affirms eligibility for new, recertification, and self-attestation applications for medication assistance through the THMP, including AIDS Drug Assistance Program (ADAP), Texas Insurance Assistance Program PLUS (TIAP-PLUS), and other special or pilot programs.
• Determines eligibility denials for applicants who do not meet program criteria, providing initial determinations and transferring requests for special exceptions and appeals to the Regional Coordinator.
• Composes letters of determination to applicants and Community Agency Enrollment Workers, including reasons for denials and information on alternative services.
• Enters all eligibility information into the THMP database, including updating demographic information and selecting the type of eligibility determination.
• Compiles and evaluates statistical data for THMP eligibility projections, providing weekly statistical information to the THMP Manager and assisting with administrative reports for the Advisory Committee.
• Serves as a liaison with local ADAP Enrollment Workers, assisting with application completion and THMP outreach efforts.
• Maintains confidentiality and handles materials requiring rapid processing.

Requirements

• Graduation from an accredited four-year college or university with major coursework in social work, public health, or health care administration is preferred.
• One year of directly related experience can substitute for two years of college.
• Experience using manual and/or automated systems to determine eligibility.
• Experience in verbal and written communication.
• Experience working with a team, setting priorities, and meeting deadlines.
• Experience in working with Protected Health Information (PHI).
• Experience working in a professional customer service environment.
• Experience in working in TakeChargeTexas (TCT) preferred.

Qualifications

• Knowledge of current social, economic, and public health issues related to HIV/AIDS; public health laws and regulations; educational techniques and procedures; and medical terminology and medications commonly used in the treatment of HIV/AIDS and STDs.
• Skills in performing applicant eligibility determination using identified screening criteria; in composing, organizing, proofreading, and editing requisitions, reports, and correspondence for accuracy and clarity; in instructing others; and in using personal computers for data entry, running reports, and developing correspondence using Excel and Word.
• Ability to train others; to interpret Public Health laws and regulations; to analyze and assess public health needs; to perform data entry with speed and accuracy; to effectively communicate verbally and in writing; to develop, implement, and evaluate policies and procedures; to understand and adhere to applicable laws and rules regarding confidential information; to plan, organize, and coordinate multiple projects while meeting strict deadlines under minimal supervision; to handle and process materials that are highly time-sensitive and that require rapid processing; and to verify client eligibility using third-party verification processes.