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CSHCS Eligibility Reevaluation Coordinator

Date Posted:  Jan 8, 2021
Requisition ID:  159821
Location: 

Indianapolis, IN, US, 46204

Work for Indiana

Grow your career with the State of Indiana! With more than 50 executive branch agencies, the State of Indiana is a diverse workforce offering employees stimulating and challenging projects across a broad scope of career opportunities. As a State of Indiana employee, you impact the well-being of Indiana’s communities every day.

 

About the Indiana Department of Health
The Indiana Department of Health’s mission is to promote, protect, and improve the health and safety of all Hoosiers.  Our vision is that every Hoosier reaches optimal health regardless of where they live, learn, work, or play.

 

This position traditionally starts at an annual salary of $28,366.  The salary for this position may be commensurate with education and job experience.

About the Job:

The purpose of this position is to coordinate the reevaluation process for continued enrollment in the Children's Special Health Care Services (CSHCS) program.

A Day in the Life:

The essential functions of this role are as follows:

  • Process reevaluation applications for program financial eligibility in accordance with the program's policies and procedures. This includes, but it not limited to:
  • Ensure that all documentation needed for eligibility determinations is complete and current. 
  • Use the family’s most recent pay stubs, IRS 1040 tax form or other specific income documentation to calculate the family’s financial eligibility, based on the relevant Federal Poverty Level (FPL) Guidelines, for the CSHCS program.
  • Determine if the participant is eligible for Medicaid and ensure the proper documentation is provided indicating they have applied.
  • Request medical documentation from participant's provider(s) to ensure sufficient medical documentation is complete before transfer to CSHCS Medical Eligibility/Prior Authorization (PA) Section for a medical eligibility determination.
  • Answer and problem solve application and eligibility related questions while being sensitive to customer needs and always try to give participants/parents referrals and resource numbers as needed.
  • Create the physical and electronic master file's for each applicant to the program and maintain filing.
  • Provide professional communication on a daily basis to participants and their families concerning  medical care and services for their child and providers that are connected to the families on the CSHCS program regarding the status of participant eligibility.
  • After eligibility determination is complete, notify the family of the results and incorporate the notification, supporting documentation, and all correspondence into the child’s master file. 
  • Receive, open, sort, date-stamp, and distribute incoming mail for the CSHCS Eligiblity Section following the CSHCS program incoming mail processing procedure.
  • Answer other eligiblity-related phone calls and triage calls appropriately using "warm call transfers" when warranted.
  • Continually update the Agency Claims Administration and Processing System (ACAPS) computer database.
  • Provide technical assistance to families and providers with completing the CSHCS program application.  
  • Be aware of and comply with all Health Insurance Portability and Accountability Act (HIPAA) guidelines and complete a yearly refresher course.
  • Keep track and submit a weekly report concerning eligibility metrics.
  • Assist supervisor in preparing for financial eligibility appeal hearings and provide testimony, if needed.
  • Starting at age 17, send the families annual resource letters explaining that their child will not be eligible for CSHCS after age 21 and detailing resources that will be useful when that event occurs.

The job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee. Other duties, responsibilities and activities may change or be assigned at any time.

What You'll Need for Success:

  • In order to effectively assist and communicate with the program’s participants,  you must have comprehensive knowledge of how the reevaluation process works, including detailed knowledge of the documents needed to do financial and medical determinations. 
  • You must be able to determine the composition of a participant’s economic group and be able to analyze income documents in order to calculate the monthly income for each group. 
  • You must become familiar with the policies and procedures concerning program eligibility and have a rudimentary knowledge of the Indiana Administrative Code concerning CSHCS. 
  • You must be familiar with computer processes and expressly with the CSHCS computer database. 
  • Written and oral communications, as well as organizational skills, are integral to the job. 
  • A formal computer workflow documents milestones for completion of specific tasks in each reevaluation determination and the incumbent must be able to organize and work under pressure.

 

Benefits of Employment with the State of Indiana:

The State of Indiana offers a comprehensive benefit package for full-time employees which includes:

  • Three (3) medical plan options (including RX coverage) and vision/dental coverages
  • Wellness program (offers premiums discount for the medical plan)
  • Health savings account (includes bi-weekly state contribution)
  • Deferred compensation account (similar to 401k plan) with employer match
  • Two (2) fully-funded pension plan options
  • Group life insurance
  • Employee assistance program that allows for covered behavioral health visits
  • Paid vacation, personal and sick time off
  • Competitive leave policies covering a variety of employee needs
  • 12 company paid holidays, 14 on election years
  • Qualified employer for the Public Service Loan Forgiveness Program
  • New Parent Leave
  • Free Parking
  • Free LinkedIn Learning

 

Equal Employment Opportunity:

The State of Indiana is an Equal Opportunity Employer

Current Employee? Click here to apply.


Nearest Major Market: Indianapolis