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Harold Gray
Eligibility Specialist
Summary
Eligibility Specialist with 5+ years of experience in determining eligibility for Medicaid and Medicare programs. Proficient in reviewing income, assets, and other factors to establish eligibility. Strong communication and problem-solving skills. Ability to work independently and as part of a team. Committed to providing excellent customer service and maintaining confidentiality.
Education
Bachelor’s Degree in Social Work
August 2016
Skills
- Eligibility Verification
- Policy and Procedure Interpretation
- Problem Solving
- Communication
- Data Entry
- Medicaid
Work Experience
Eligibility Specialist
- Provided guidance and assistance to clients on eligibility requirements and the application process.
- Collaborated with healthcare professionals and case managers to ensure appropriate access to healthcare services.
- Maintained accurate and detailed case files, documenting eligibility determinations and supporting documentation.
- Participated in training and workshops to stay abreast of changes in eligibility criteria and policies.
Eligibility Specialist
- Determined eligibility for Medicaid and Medicare programs, reviewing income, assets, and other factors.
- Verified documentation, such as tax returns, pay stubs, and medical bills, to establish eligibility.
- Interviewed clients and collected information to assess eligibility and determine appropriate benefits.
- Processed applications and made eligibility determinations within established timeframes.
Accomplishments
- Successfully implemented a streamlined intake process, reducing processing time by 20%, resulting in improved customer satisfaction.
- Collaborated with medical providers to improve communication and increase accuracy of medical documentation, ensuring appropriate eligibility decisions.
- Developed and implemented a training program for new eligibility specialists, resulting in a 15% improvement in overall knowledge and skills.
- Conducted thorough eligibility screenings, ensuring accurate and timely enrollment in government programs, benefiting over 500 individuals.
- Established strong relationships with community organizations, providing valuable resources and support to individuals seeking eligibility assistance.
Awards
- Recognition for Outstanding Performance in Eligibility Determination, exceeding state and federal accuracy standards.
- Recipient of the Healthcare Excellence Award for exceptional customer service and case management skills.
- Honored as Employee of the Quarter for consistently exceeding expectations in benefits administration.
- Recognized for innovative ideas in improving the efficiency of eligibility processes.
Certificates
- Certified Eligibility Specialist (CES)
- Certified Medicaid Specialist (CMS)
- Certified Application Counselor (CAC)
- Certified Welfare Specialist (CWS)
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How To Write Resume For Eligibility Specialist
- Highlight your experience in determining eligibility for Medicaid and Medicare programs.
- Demonstrate your strong communication and problem-solving skills.
- Showcase your ability to work independently and as part of a team.
- Emphasize your commitment to providing excellent customer service and maintaining confidentiality.
- Quantify your accomplishments whenever possible, using specific numbers and metrics.
Essential Experience Highlights for a Strong Eligibility Specialist Resume
- Determined eligibility for Medicaid and Medicare programs based on income, assets, and other factors.
- Verified documentation, such as tax returns, pay stubs, and medical bills, to establish eligibility.
- Interviewed clients and collected information to assess eligibility and determine appropriate benefits.
- Processed applications and made eligibility determinations within established timeframes.
- Provided guidance and assistance to clients on eligibility requirements and the application process.
- Collaborated with healthcare professionals and case managers to ensure appropriate access to healthcare services.
- Maintained accurate and detailed case files, documenting eligibility determinations and supporting documentation.
Frequently Asked Questions (FAQ’s) For Eligibility Specialist
What is the role of an Eligibility Specialist?
An Eligibility Specialist determines eligibility for government programs such as Medicaid and Medicare. They review income, assets, and other factors to establish eligibility and provide guidance to clients on the application process.
What are the key skills required for an Eligibility Specialist?
Eligibility Specialists should have strong communication and problem-solving skills, as well as the ability to work independently and as part of a team. They should also be proficient in reviewing and verifying documentation, and have a thorough understanding of eligibility criteria and policies.
What is the job outlook for Eligibility Specialists?
The job outlook for Eligibility Specialists is expected to grow faster than average over the next decade. This is due to the increasing number of people who are eligible for government assistance programs.
What is the average salary for an Eligibility Specialist?
The average salary for an Eligibility Specialist varies depending on experience, location, and employer. However, according to the U.S. Bureau of Labor Statistics, the median annual salary for Social and Human Service Assistants, which includes Eligibility Specialists, was $37,720 in May 2021.
What are the benefits of working as an Eligibility Specialist?
Working as an Eligibility Specialist offers several benefits, including the opportunity to make a difference in the lives of others, job security, and opportunities for career advancement.
What are the challenges of working as an Eligibility Specialist?
Working as an Eligibility Specialist can be challenging due to the high volume of work, the need to stay up-to-date on changing regulations, and the potential for dealing with difficult clients.