Job Specifications

SANTA CRUZ COUNTY

Under general supervision, to determine initial eligibility for medical care services to the County's indigent population; to recertify eligibles in cases of continuing medical need; to assist with case management and to do other work as required.

Positions in this class have responsibility for determining eligibility for medical services under the County's indigent care program. Positions in this class perform journey level assignments specializing in the application of eligibility criteria for medical care benefits. Duties include a wide variety of clerical tasks.

Assists applicants to complete the necessary questionnaires, declarations, records, registration and other forms; interviews applicants to explain the County medical care program, scope of benefits, procedures and authorization process; obtains data on income and assets necessary to determine eligibility, program coverage, current medical need and potential share of cost; secures verification of employment status, income, family composition, assets and residency; screens for linkage to other medical assistance programs to which applicant may be entitled such as MediCal, Social Security Disability, Veteran's, Worker's Compensation, or private insurance; records pertinent information, computes budget and evaluates application for program eligibility; conducts interviews at County offices, clinic sites and hospitals; communicates with hospitals and medical providers to inform them of program elements, to schedule recipients for services, to expedite authorization in cases of immediate needs, and to verify eligibility of inpatients admitted in emergency; accepts and assists in completion of appropriate MediCal forms for hospitalized patients; may prepare authorization for prescribed medicines, specialist services, or hospital admission upon referral from clinic staff, designated physicians or providers; maintains program statistics to records applications, registration of eligibles, referrals, specialist services, admissions, discharges and length of stay; processes patient case data on computers to correct and update file information; assists in resolving complaints of applicants, recipients, or medical providers; attends meetings and participates in training; completes surveys and compiles information as needed; may assist in orientation and training to new employees; provides vacation back-up and temporary relief for other employees as required.

• Thorough knowledge of the regulations governing eligibility in the MediCal Program;
• Working knowledge of government medical insurance programs: e.g., Social Security, Veteran's or Worker's Compensation;
• Working knowledge of interviewing techniques for obtaining factual information;
• Working knowledge of the methods and principal sources of information necessary to establish eligibility for public
• assistance;
• Working knowledge of methods of organizing work;
• Working knowledge of data compilation and record keeping practices;
• Some knowledge of medical service providers within the community, hospitals, clinics, nursing homes, physicians
• groups, and pharmacies;
• Some knowledge of medical terminology and practices;
• Some knowledge of common community resources and other public assistance programs;
• Some knowledge of human motivation and behavior.

• Explain and apply complex regulations and policies governing public and private medical assistance programs;
• Evaluate information pertinent to eligibility determination;
• Apply effective interviewing techniques to elicit case information;
• Establish and maintain effective working relationship with agency staff, clientele, service providers and the public;
• Ascertain and implement cost-effective alternatives for medical care services;
• Code, input and retrieve computerized program data and case records;
• Maintain accurate records and statistics;
• Recognize problems warranting referral to social services agencies;
• Accurately perform mathematical calculations required to determine eligibility, Prepare reports and summarize data.

Training and Experience: Any combination of training and experience, which would provide the required knowledge and abilities, is qualifying. A typical way to gain these knowledge and abilities would be:

One year of experience equivalent to Eligibility Worker II in the Santa Cruz County system assigned responsibilities for MediCal eligibility determination.