MEDICAL CARE ELIGIBILITY WORKER
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.
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.