Eligibility Specialist Resume Samples

An Eligibility Specialist will determine if the applicant meets the necessary criteria for getting qualified for various programs. A well-drafted Eligibility Specialist Resume mentions the following duties and tasks – gathering information pertaining to public assistance program applications, identifying the required client data, verifying reviewing submitted applications, gathering admission forms, judging the competence of the candidates, sending letter of acceptance to selected candidates, reviewing application and checking if the application is worthy of scholarship, and rejecting applications that don’t fulfil the admission criteria.

While the job description may vary based on the industry, the required skills are common and include these – a thorough knowledge of the rules protocols pertaining to the industry, analytical skills, proficiency in the documentation, and sound researching skills. Education requirements vary for this position, but successful resumes depict a degree in relevant fields.

 

Eligibility Specialist Resume example

Eligibility Specialist Resume

Objective : Motivated, personable business professional with a talent for quickly mastering technology, rules and regulations. Diplomatic and tactful with professionals and non-professionals at all levels. Accustomed to handling sensitive, confidential records. Demonstrated history of producing accurate, timely reports meeting stringent guidelines. Flexible and versatile - able to maintain a sense of humor under pressure.

Skills : Proficient in English & Spanish - verbal and written.

Description :

    1. Perform intermediate administrative work evaluating and explaining program benefits and eligibility requirements to applicants and clients, processing applications and recertification, according to county, state and federal policies, statutes and guidelines, and related work as apparent or assigned.
    2. Processes case specific information for applications, recertification and unscheduled reported changes into state and county databases.
    3. Determines eligibility for a variety of county, state and federal public assistance programs.
    4. Advises clients on viable life options; provides referrals for other resources; promotes self-sufficiency.
    5. Works in cooperation and coordination with other county staff, local, state and federal agencies, service providers or vendors to provide client services.
    6. Solely responsible for up to 800 foster care cases.
    7. Responds to client concerns and complaints; informs clients of their appeal rights and the appeals process.
Years of Experience
Experience
2-5 Years
Experience Level
Level
Junior
Education
Education
Biology


Eligibility Specialist II Resume

Summary : Seeking a challenging opportunity that will utilize my vast work experience and skills to further a company's success.

Skills : management, inventory, deadline managment.

Description :

    1. Eligibility Determiner Administered the intake, assessment, and eligibility process for JTPA, Veterans Program, Three Rivers Youth, and Older Adult Employment Program, SPOC, Female Offenders Program, and Renewal Inc.
    2. Reviewed applications in detail to determine eligibility status of clients and explained available services.
    3. Trained as an Administrative Assistant to the Helpline/United Way agency representative on site.
    4. Identified client's supportive service needs and made appropriate referrals.
    5. Administered and scored employment and training evaluation tests.
    6. Accurately completed agency forms and input data into computer.
    7. Organized and maintained efficient records and effectively communicated with clients.
Years of Experience
Experience
10+ Years
Experience Level
Level
Senior
Education
Education
Certificate Of Completion


Healthcare Eligibility Specialist Resume

Objective : A professional receptionist/ front office assistant with solid track-record of consistently meeting assigned goals and objectives through self-discipline, perseverance and motivation. Confident and poised in interactions with individuals at all levels. Detail-oriented and resourceful in completing projects with the ability to multitask effectively in a timely manner. Versatile professional with hands-on experience in diverse industries operating multiple functions nationally.

Skills : Microsoft Office, ICES, FACTS, SMART, Excel,Word, multiple systems in unison.

Description :

    1. Determine client eligibility for program by using HUD Income Limits.
    2. Process Lease Renewals, Lease Adjustments, Unit Transfers, and New Lease Contracts for tenants via Lindsey Software.
    3. Initiate and investigate tenant fraud cases, monitor repayment agreements to agency, monitor Debts Owed.
    4. Issue vouchers during Vouchers sessions, assist tenants/landlords with Agency and HUD guidelines.
    5. Perform intake when agency is taking applications for assistance and place eligible clients on waiting list.
    6. Perform background checks for potential tenants.
    7. Represent agency during tenant requested hearings.
    8. Assist Director with processing monthly rent checks to landlords.
Years of Experience
Experience
2-5 Years
Experience Level
Level
Junior
Education
Education
Social Work

Medicaid Eligibility Specialist Resume

Objective : Hard working and fully certified Medical Coding Specialist seeking an opportunity in a medical administrative environment. Solid continuous work history showing a track record efficiency and accuracy. Proven ability to meet deadlines in high pressure environments with keen attention to detail. Extensive work in medical billing makes me an important key asset to any organization.

Skills : Word, Excel.

Description :

    1. Ensures compliance with all processes, and procedures and directives pertaining to paratransit and fixed-route systems that affect paratransit customers Ensures that all eligibility determinations for MetroAccess are processed accurately and within 21 days or less from receipt of completed application.
    2. Ensures applicants who meet the guidelines of the ADA are determined eligible for the appropriate level of paratransit service.
    3. Work with leadership and colleagues to refine processes and procedures to achieve greater efficiency and cost effectiveness.
    4. Conduct an assessment of the travel skills and goals of people with disabilities and senior citizens through interviews and observations.
    5. Print MetroAccess ID cards and mail them to customers when they are eligible for the service.
    6. Ensures that all customer data is correct before printing and mailing the MetroAccess ID cards.
    7. Provides quality customer service to internal and external customers.
    8. Answer telephone calls to trouble-shoot problems, and schedule assessment appointments.
Years of Experience
Experience
2-5 Years
Experience Level
Level
Junior
Education
Education
Bachelor's Of Science In Nursing

Bilingual Eligibility Specialist Resume

Objective : Motivated customer service specialist with 3 years of experience in telephone customer service, including sales, tech support, and customer care. Familiar with major customer service software, conflict resolution, and posses a positive attitude. Utilizing my proven skills, I believe I am able to effectively fill any office position.

Skills : Answering Phones, Schedule Appointments, Insurance Verification, Medical Records, Medical Billing, Collections, Cash Handling, Interpreting, Training, Case Processing.

Description :

    1. Analyze process and determine electronic applications for FAMIS and FAMIS Plus state health insurance for pregnant women and children using CHAMPS and MMIS.
    2. Contact clients when application is deficient for needed information Send letters to clients when application is deficient using CHAMPS.
    3. Analyze, verify and calculate earned and unearned income, including pay stubs, unemployment, SSA, etc.
    4. Route applications and verifications to appropriate queue using office computer software ODM.
    5. Understand and follow regulations for state eligibility.
    6. Complete correction, cancellation, address and transfer reports as needed.
    7. Communicate with local Department of Social Services via appropriate office forms when necessary.
    8. Responsible for accuracy, consistency and meeting quota expectations.
Years of Experience
Experience
2-5 Years
Experience Level
Level
Junior
Education
Education
Creative Advertising

Benefits Eligibility Specialist Resume

Headline : I am an experienced and goal-oriented professional with a track record of consistently achieving and exceeding established goals and objectives related to management, training, education, and client relations. 1. I have four and one half years of experience working as a Psychosocial Rehabilitation Specialist (PSR) for Vista Family Services of Idaho. In that capacity I managed large caseloads and worked closely with Medicaid clients, counseling them on how to live more healthful and productive lives.

Skills : Type 75 WPM, Fluent in American Sign Language, Dental and Medical Front and Back Office.

Description :

    1. Analyze process and determine electronic applications for FAMIS and FAMIS Plus state health insurance for pregnant women and children using CHAMPS and MMIS.
    2. Contact clients when application is deficient for needed information Send letters to clients when application is deficient using CHAMPS.
    3. Analyze, verify and calculate earned and unearned income, including pay stubs, unemployment, SSA, etc.
    4. Route applications and verifications to appropriate queue using office computer software ODM.
    5. Understand and follow regulations for state eligibility.
    6. Complete correction, cancellation, address and transfer reports as needed.
    7. Communicate with local Department of Social Services via appropriate office forms when necessary.
    8. Responsible for accuracy, consistency and meeting quota expectations.
Years of Experience
Experience
5-7 Years
Experience Level
Level
Consultant
Education
Education
Creative Advertising

Employment And Eligibility Specialist Resume

Summary : Eligibility Specialist with a background in customer service, casino work, and call centers. Warm, outgoing personality with the ability to interact successfully with persons of all ages and backgrounds.

Skills : Microsoft office 2010'-2016', Apple iWorks.

Description :

    1. Greet participants entering the help center in a positive, professional and friendly manner.
    2. Gather information from the participant to best direct them to services.
    3. Receive, route and respond to phone calls.
    4. Schedule/Reschedule appointments and follow up on no shows.
    5. Track Medicaid disability claims and medical records.
    6. Meet with participants to determine eligibility for federal or state funded programs.
    7. Maintain confidentiality of patient health information in compliance with HIPAA regulations.
Years of Experience
Experience
7-10 Years
Experience Level
Level
Management
Education
Education
High School Diploma

Eligibility Specialist Case Manager Resume

Objective : Dynamic team leader with more than ten years of exceptional customer service experience with a demonstrated record of success working in the customer service industry. Excellent communication and interpersonal skills with keen ability to, articulate requirements and provide solutions. otivated professional with strong passion for human flourishing and public M service.

Skills : Management.

Description :

    1. Randstad/Maximus Review applications ensuring that applications are filled out correctly and fully and contacting applicants and or others to verify the information supplied on applications.
    2. Process applications which includes performing social summaries, obtaining releases, collecting medical records.
    3. Assist applicants in determining verification of income, assets and other legal and financial documents.
    4. Explain various programs provided, verify documents as necessary and explain the regulations to meet the program requirements.
    5. Enter information into the automated system to determine eligibility for Medicaid and other state programs.
    6. Process, read, and interprets data elements on all applicable systems to provide support, resolve inquires, and educate callers.
    7. Process enrollments Fees, plan changes, and disenrollments.
    8. Communicate with clients and other internal departments.
Years of Experience
Experience
0-2 Years
Experience Level
Level
Entry Level
Education
Education
Bachelor Of Science

Eligibility Specialist/Patient Care Coordinator Resume

Summary : Competent and supportive Case Manager with 20 years experience in patient / client advocacy and eligibility. Adept, multi-tasking working with people with disabilities.

Skills : Microsoft Office.

Description :

    1. Screened and Interviewed Applicants to determine initial and on-going eligibility services.
    2. Developed detailed, Individualized case management plans for clients.
    3. Conducted home visits field reviews using OR access, CAPS assessment tool and laptop.
    4. Interviewed clients, and updated OR ACCESS computer system to input information.
    5. Used MMIS to verify, collect and enter accurate data for benefit Issuance.
    6. Worked in cooperation with other DHS agencies and community partners to develop integrated service plans.
    7. Assisted clients by problem solving, providing tools such as administrative hearings requests, consumer comment forms, alternate formats, and civil rights forms.
    8. Assisted clients in finding either In-home care, or Residential care facility, based upon care needs.
Years of Experience
Experience
7-10 Years
Experience Level
Level
Consultant
Education
Education
Associates In Social Work

Billing & Eligibility Specialist Resume

Headline : To obtain a challenging position in the insurance field where my skills and knowledge will develop to help my growth within a fortune five hundred company..

Skills : Microsoft Office.

Description :

    1. Provide the highest quality of customer service to patients and client representatives, which entail acquiring in depth knowledge of client and marketing requirements.
    2. Complete verification of Benefits and Eligibility for all referrals from patients, MDOs, health plans and pharmaceutical manufacturers.
    3. Completed Investigation of benefits and eligibility by phone and/or internet to determine coverage choices patient has when starting a therapy.
    4. Review incoming referrals for completeness and confirm all requirements are met.
    5. These are typically received via facsimile, Web portal or client partner download.
    6. Complete verification of Benefits and Eligibility for all referrals from patients, MDOs, health plans and pharmaceutical manufacturers.
    7. Investigation of benefits and eligibility by phone and/or internet to determine coverage choices patient has when starting a therapy.
Years of Experience
Experience
5-7 Years
Experience Level
Level
Management
Education
Education
High School Diploma

Eligibility Specialist/Patient Advocate Resume

Summary : Objective: To obtain a challenging position in which I can utilize my skills and prior experiences to my fullest potential.

Skills : Microsoft Office Programs, Office Applications, Office Administration, Networking, Receptionist, Switchboard, Government Relations, Medical Terminology, Public Relations.

Description :

    1. Provided administrative support to department supervisors and staff.
    2. Processed initial review of health care insurance applications and required documentation.
    3. Maintained well-organized filing system that allowed for easy tracking of information.
    4. Opened, sorted, organized, distributed and responded to mail and email.
    5. Filtered through high volume of telephone calls with responsibility for timely follow up.
    6. Learned to work efficiently under pressure.
    7. Reviewed data records, charts and reports for data entry.
Years of Experience
Experience
7-10 Years
Experience Level
Level
Management
Education
Education
High School Diploma

Eligibility Specialist Resume

Summary : Medical Front Office Medical/Banking Billing and Collecting Worked with all major insurance companies Insurance verification/denials/appeals/EOB's Customer Service.

Skills : customer services, Medical Terminology, Computer Skills: Microsoft Word, Ices, Customer Service, Data Entry, Insurance Verification.

Description :

    1. Process applications, re-determinations and other supporting documents relevant to cases.
    2. Reviews applications for eligibility requirements and completeness.
    3. Enters enrollment data into computer system.
    4. Follows up with consumer contacts with correspondence to clarify information or update files.
    5. Finalized eligibility once all pertinent information added into the system.
    6. Reports any technical problems with equipment, systems or facilities to Manager.
    7. Determine if consumer meets eligibility requirements.
    8. Complete various clerical tasks associated with customer service.
Years of Experience
Experience
7-10 Years
Experience Level
Level
Consultant
Education
Education
BS