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PROGRAM ELIGIBILITY ANALYST
The Program Eligibility Analyst is responsible for determining client eligibility for government programs. This position is governed by state and federal laws and agency/institution policy.
Class Code:
M038C
Job Grade:
GS06
Special Job Requirements:
None
Typical Functions:
Requests and compiles evidence from sources, including employers, claimants, physicians, hospitals, and health agencies, by contacting parties via telephone or correspondence in order to make claim determination. Reviews medical and non-medical evidence for compliance by comparing claim evidence provided to applicable federal rules and regulations. Interprets and communicates eligibility requirements, policies, and procedures to internal and external customers and writes and/or completes reports, correspondence, eligibility decision, and summary forms regarding findings. Determines the need for independent medical evidence, such as consultative examinations, by reviewing case files and supporting medical documentation. Prepares written vocational analyses by reviewing vocational requirements, considering individual’s capacity to perform past work or ability to transfer to other work, reading vocational rule tables, noting age, education, and skills of individual, and consulting vocational consultant. Confers with medical consultants for interpretation and analysis of technical medical data by phone or correspondence. Attends staff meetings to review problems, provide input into policy and procedure review and development, and address community-based support issues. May serve as mentor by training program eligibility assistants, technicians, or specialists. Performs other duties as assigned.
Knowledge, Abilities, and Skills:
Knowledge of policies, procedures, and regulations used in applying and interpreting eligibility criteria for the respective program. Knowledge of interviewing/referral techniques. Ability to resolve problems. Ability to communicate both orally and in writing. Ability to interpret and apply policies, procedures, and guidelines in determining eligibility for assistance programs. Ability to evaluate client information, assess client needs, and make referrals. Ability to evaluate case information and determine eligibility for programs.
Minimum Qualifications:
The formal education equivalent of a bachelor’s degree in psychology, sociology, or a related field; plus two years of experience in determining eligibility for social programs. Additional requirements determined by the agency for recruiting purposes require review and approval by the Office of Personnel Management. OTHER JOB RELATED EDUCATION AND/OR EXPERIENCE MAY BE SUBSTITUTED FOR ALL OR PART OF THESE BASIC REQUIREMENTS, EXCEPT FOR CERTIFICATION OR LICENSURE REQUIREMENTS, UPON APPROVAL OF THE QUALIFICATIONS REVIEW COMMITTEE.
Required Certificates:
None
Exempt:
E
