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Functional Title: SH Eligibility Support Specialist
Job Title: Eligibility Advisor V
Agency: Health & Human Services Comm
Department: Title V MOE CSHCN
Posting Number: 18691
Closing Date: 07/24/2026
Posting Audience: Internal and External
Occupational Category: Community and Social Services
Salary Range: $3,581.33 - $4,476.83
Pay Frequency: Monthly
Salary Group: TEXAS-B-17
Shift: Day
Additional Shift:
Telework:
Travel:
Regular/Temporary: Regular
Full Time/Part Time: Full time
FLSA Exempt/Non-Exempt: Nonexempt
Facility Location:
Job Location City: AUSTIN
Job Location Address: 701 W 51ST ST
Other Locations:
MOS Codes: No military equivalent
Brief Job Description:
Under the general direction of the Specialty Health Eligibility Supervisor, performs advanced (senior-level) eligibility determination work for the Kidney Health Care (KHC), Children with Special Health Care Needs (CSHCN) Services Program, and the Hemophilia Assistance Program (HAP). Works under minimal supervision, with considerable latitude for the use of initiative and independent judgment. Responsibilities include determining eligibility, providing technical assistance to internal and external partners for the completion of program eligibility, and maintaining client eligibility status. Coordinates and verifies client benefits. Monitors clients to ensure compliance with rules, policies, and procedures. Makes recommendations for action based on findings. Responds to inquiries regarding eligibility determination of benefits. Conducts reviews to determine or verify new and continues program eligibility. May calculate and/or assist with process changes to client benefits such as overpayment, adjustments, or restoration of benefits. Documents case records to maintain accurate and confidential client records.
Essential Job Functions (EJFs):
1. Screening and Eligibility Determination
Determine initial and renewal eligibility for the Specialty Health (SH) programs, including Kidney Health Care (KHC) Program; Children with Special Health Care Needs (CSHCN) Services Program; Hemophilia Assistance Program (HAP); along with eligibility support with other SH programs. Manage receipt of application and documents for eligibility determination (including proof of income, residency, identification and insurance information); collect, assess and determine if there are any missing pieces of information for determination in a timely and effective manner. Professionally communicate throughout the determination process, as needed with social workers, case managers or client/client representatives. - 25%
2. Case Management and Application Processing
Identify, verify, and validate all third-party insurance coverage’s during the application determination process. Correctly coordinate all third-party benefits in accordance with program rules, policies, and procedures. Submit correct coordination plan to the SH Eligibility Team's Insurance staff and verify that they have coordinated the client benefits correctly and accurately. Uploads and organizaes elctronic documentation for verification and review - 25%
3. Collaboration and Team Support
Works with supervisors, other team members and SH Customer Support team to coordinate services and ensure client, social worker and case manager communication and guidance is current, accurate, professional and helpful. Participate in team meetings, trainings and continuous improvement initiatives. Shares best practices and assists with onboarding or training new staff when needed - 15%
4. Compliance and Quality Assurance
Maintain accurate case records for KHC, CSHCN and HAP clients in agency systems, ensuring all data is complete and compliant.
Ensure meeting standards for timeliness and accuracy in all client record updates and entries. Manage assigned caseload efficiently while meeting productivity and quality standards. Maintain confidentiality and follow all HIPAA and privacy standards. Participate in audits, quality reviews and error-correction processes. Keeps up-to-date with policy changes and updates procedures accordingly - 15%
5. Communication, Outreach and Program Education
Serve as an eligibility subject matter expert to internal and external customers and other stakeholders. Assist all stakeholders in understanding SH eligibility rules and requirements. Offer concise answers and provides easily understandable examples of eligibility and system processes. Attend meetings and conference calls as assigned to provide expertise and stay knowledgeable of current changes to the program by attending trainings and staying knowledgeable with updates to policy and procedure manuals - 15%
6. Other duties as assigned
Other duties as assigned include but are not limited to actively participating and/or serving in a supporting role to meet the agency’s obligations for disaster response and/or recovery or Continuity of Operations (COOP) activation. Such participation may require an alternate shift pattern assignment and/or location - 5%
Knowledge, Skills and Abilities (KSAs):
Knowledge of: state and federal program eligibility guidelines, regulations, and policies; social services eligibility requirements; and community welfare resources; of community and government service delivery systems; of case management delivery systems; of state and federal laws, case guidelines, regulations, and policies; of programs which support client populations served by Specialty Health about the evaluation of eligibility; of individual needs associated with special health care needs/disabilities and related community welfare resources.
Skill in: interviewing, in conducting individual needs assessments, and in the use of a computer and applicable software; in interviewing and communicating with clients, case managers, and social workers for the purpose of conducting individual needs assessments; in providing technical assistance to providers, clients, and professional staff; in navigating interagency procedures; in providing customer service support to clients and providers regarding complex eligibility requirements and benefits.
Ability to: convey instructions and explanations to clients and interested parties; to negotiate available services for our client population; to develop and interpret policies and procedures, and to assess compliance; to communicate effectively with coworkers, clients, and providers; to work effectively as a team member; to maintain effective working relationships; to elicit and evaluate information; to research and investigate; to perform basic arithmetic and data analysis; and to communicate effectively; to serve as a lead worker providing direction to others.
Registrations, Licensure Requirements or Certifications:
N/A
Initial Screening Criteria:
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At least two years’ experience reviewing applications and supporting documentation to determine eligibility for client service or social service programs such as Medicaid/Medicare, CHIP, or other public benefit programs.
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Experience using automated computer systems and databases to review and confirm supporting documentation for service program eligibility;
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Experience in providing customer service to clients and providers regarding complex eligibility requirements and program benefits.
Preferred Screening Criteria:
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Experience with Medicare, Medicaid, and CHIP regulations relating to eligibility, coordination of benefits, insurance, and third-party coverage.
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Experience using Health and Human Services software systems.
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Active Duty, Military, Reservists, Guardsmen, and Veterans:
Military occupation(s) that relate to the initial selection criteria and registration or licensure requirements for this position may include, but not limited to those listed in this posting. All active-duty military, reservists, guardsmen, and veterans are encouraged to apply if qualified to fill this position. For more information please see the Texas State Auditor’s Job Descriptions, Military Crosswalk and Military Crosswalk Guide at Texas State Auditor's Office - Job Descriptions.
ADA Accommodations:
In compliance with the Americans with Disabilities Act (ADA), HHSC and DSHS agencies will provide reasonable accommodation during the hiring and selection process for qualified individuals with a disability. If you need assistance completing the on-line application, contact the HHS Employee Service Center at 1-888-894-4747. If you are contacted for an interview and need accommodation to participate in the interview process, please notify the person scheduling the interview.
Pre-Employment Checks and Work Eligibility:
Depending on the program area and position requirements, applicants selected for hire may be required to pass background and other due diligence checks.
HHSC uses E-Verify. You must bring your I-9 documentation with you on your first day of work. Download the I-9 Form
Telework Disclaimer:
This position may be eligible for telework. Please note, all HHS positions are subject to state and agency telework policies in addition to the discretion of the direct supervisor and business needs.
