ADRC Elder Benefit Specialist I/II

POSITION SUMMARY:

This position provides benefits counseling, advocacy, information, advice, and assistance to St. Croix County residents age 60 and older regarding eligibility for and problems with public benefits and services, health care financing, insurance, housing, and other financial and consumer concerns within the Elder Benefit Specialist (EBS) Program benefits scope. The position helps customers understand their rights and options, obtain or maintain benefits, address adverse benefit decisions, and complete appeals when appropriate. Services promote the autonomy, dignity, independence, and financial security of older adults and are provided in accordance with Wisconsin Stat. § 46.81, the Wisconsin Department of Health Services EBS Program Operations Manual, and applicable state and local policies. 

  
ESSENTIAL FUNCTIONS: 
The following duties are normal for this position. These are not to be construed as exclusive or all-inclusive. To perform this job successfully, an individual must be able to perform each duty satisfactorily. Other duties may be required and assigned. 

• Handles EBS case intakes and referrals and provides accurate, timely information, advice, benefits check-ups, counseling, and assistance regarding public benefits and services, health care financing, insurance, housing, and other financial and consumer concerns within the EBS Program benefits scope.


• Provides customer-directed advocacy and, when appropriate, direct representation in benefit applications and administrative appeals. Consults regularly with the EBS program attorney for technical assistance, case-merit analysis, advocacy strategy, and referrals for legal representation; follows formal representation requirements when applicable.


• Assists customers with applying for, renewing, obtaining, and maintaining benefits and services within the EBS Program benefits scope, including gathering supporting documentation and completing and submitting appeals. Provides services in the office, in customers’ homes or community locations, by telephone, virtually, by email, and through written correspondence, as appropriate.


• Determines EBS service eligibility and applies the EBS Client Services Agreement, case acceptance, prioritization, caseload management, service limitation, case closure, and case termination policies. Distinguishes informational contacts from cases and monitors open cases to move them toward timely resolution.


• Maintains the EBS Program’s strict confidentiality standards; obtains informed consent and specific releases when required; protects customer records; and promptly consults the program attorney regarding potential conflicts of interest, suspected fraud, subpoenas, legal requests, elder-abuse reporting considerations, and other issues identified by program policy.


• Maintains complete, accurate, timely, and confidential case files, case notes, Client Services Agreements, supporting documents, and records in the required case-management and reporting systems. Complies with state, federal, SHIP, Medicaid Administrative Claiming, and County reporting requirements, including 100% time and task reporting, and generates records needed for annual case review.


• Develops and maintains in-depth knowledge of benefit programs, laws, regulations, policies, and advocacy strategies. Completes EBS program orientation, initial training, job shadowing, and all mandatory ongoing training required by the program attorney and the Wisconsin Department of Health Services. Completes and maintains State Health Insurance Assistance Program (SHIP) counselor certification as required.


• As assigned, assists with the recruitment, training, and development of EBS program volunteers and ensures volunteers understand their roles and the applicable confidentiality and conflict-of-interest requirements.


• Conducts accessible outreach and community education so older adults throughout the County understand EBS advocacy services and their rights, benefits, and entitlements, including Medicare, Medicaid, Social Security, health insurance, and other topics within the EBS Program benefits scope.


• Develops and distributes accurate informational and outreach materials; provides presentations, workshops, and other community education; submits newsletter or media content; and prepares clear customer and agency correspondence.


• Research benefit laws, policies, and procedures; identifies customer goals, relevant benefits, evidence, deadlines, barriers, and advocacy options; explains the advantages and disadvantages of available options; and prepares advocacy correspondence and documentation consistent with the customer’s informed decisions.


• Supports program quality improvement by participating in customer satisfaction and needs assessment activities, annual program-attorney case review, program monitoring, and implementation of identified improvements.


• Clearly identifies the customer and, when applicable, the authority and scope of a guardian or other surrogate decision maker; includes the customer in conversations and decisions to the fullest extent possible; and obtains explicit permission before working with another person on the customer’s behalf.


• Calculates and tracks application and appeal deadlines, identifies tasks and timelines with the customer, communicates case status promptly, and clearly distinguishes the responsibilities of the customer and the EBS.


• Does not determine or certify benefit eligibility, perform long-term care functional screens, perform SSI-E eligibility determinations, provide guardianship or adult protective services, serve as the agency’s lead information and assistance worker, or provide substantive case assistance outside the approved EBS Program benefits scope.


• Uses County position, funds, title, and affiliation only in accordance with EBS restrictions on partisan political activity and lobbying and applicable County policy. Consults the program attorney before engaging in advocacy involving elected or agency officials when required.


• Maintains accountability to the County for job performance, including adherence to agency policies, caseload and time management, productivity, prioritization, case and file management, and required reporting, while maintaining the independent, customer-directed advocacy responsibilities of the EBS role.

KNOWLEDGE, SKILLS AND ABILITIES   
This section details the essential competencies required to perform the job effectively, including a mix of technical knowledge, practical skills, and personal attributes. 

• Understanding of the structure, functions, and procedures of local, state, and federal government agencies, particularly those serving Wisconsin residents. 


• Knowledge of, or ability to learn and apply, federal and state laws, regulations, policies, and procedures governing public benefits, insurance, consumer rights, EBS services, and applicable County programs and policies.


• Knowledge of community resources, public services, social programs, and other available resources, with the ability to make appropriate referrals, including referrals for services or legal representation outside the EBS Program benefits scope.


• Knowledge of advocacy principles, customer self-determination, informed consent, confidentiality, conflicts of interest, professional boundaries, and customer-directed service practices.


• Ability to provide person-centered, customer-directed services that respect each customer’s autonomy, goals, capabilities, and right to make informed decisions.


• Knowledge of and sensitivity to cultural differences and the needs of diverse populations and individuals with varying abilities or circumstances.


• Ability to provide effective customer service and interact professionally, respectfully, and tactfully with customers, coworkers, agencies, service providers, and the public, including individuals experience stressful or difficult circumstances. 


• Skill in interviewing, benefits counseling, explaining complex information, and supporting customers in understanding and exercising their rights and options.


• Skill in case intake, case analysis, caseload prioritization, evidence development, deadline management, documentation, negotiation, and administrative advocacy.


• Ability to maintain accurate, timely, organized, and confidential case records, documentation, reports, and electronic records in accordance with program and County requirements.


• Strong organizational and time management skills, including the ability independently organize and prioritize a complex caseload, manage competing deadlines, adapt to changing priorities and work demands, and seek timely technical assistance when appropriate.


• Technical proficiency in the use of case-management, reporting, research, virtual meeting, and standard office technology, including word processing, data entry, standard office software, multi-line telephone systems, and office technology. 


• Ability to establish and maintain effective working relationships and work effectively as part of a team, including collaborating with other staff and departments to achieve common goals. 

LANGUAGE SKILLS   
This section outlines the communication abilities necessary for effective performance.  These skills reflect the need to interact with the public, colleagues, and other stakeholders in a clear, professional, and effective manner. 

• Ability to communicate effectively in English, both verbally and in writing, with a wide range of individuals, including the public, colleagues, and supervisors.


• Ability to read, interpret, and apply information from complex documents such as laws, regulations, policies, procedures, and reports.


• Ability to engage with the public, handle inquiries, resolve conflicts, and build positive relationships with a diverse population.


• Ability to explain complex or technical information in a clear, understandable manner.


• Ability to listen actively and accurately understand verbal instructions or concerns.

MATHEMATICAL SKILLS 

• Ability to perform mathematical calculations. 


• Ability to apply basic mathematical concepts when reviewing or assisting customers with benefit, financial, insurance, and other related information. 

REASONING ABILITY 
This section outlines the cognitive skills required to perform the job effectively.  This includes the ability to apply logic, make decisions, solve problems, and understand complex information.  

• Ability to identify and define problems, collect data, establish facts, and draw valid conclusions.


• Ability to analyze facts, benefit rules, notices, evidence, and case merit; identify appropriate advocacy strategies; and exercise sound professional judgment in consultation with the program attorney.


• Ability to analyze situations, consider various perspectives, recognize patterns and potential issues, and determine appropriate courses of action based on logical reasoning.


• Ability to evaluate case merit, identify issues and potential barriers, and develop appropriate advocacy strategies within the scope of the EBS Program.


• Ability to make sound, well-informed, and timely decisions and recommendations, including in stressful or crisis situations, while exercising appropriate professional judgment.


• Ability to apply applicable laws, regulations, policies, procedures, and advocacy principles when evaluating cases and determining appropriate actions.


• Ability to organize and prioritize a complex caseload, establish appropriate timelines, manage competing deadlines, and adjust priorities based on changing circumstances.


• Ability to recognize when technical assistance, consultation with the program attorney, or other staff expertise is necessary and seek assistance in a timely manner.


• Ability to identify and promptly address actual or potential conflicts of interest, confidentiality concerns, ethical issues, and matters that may affect the provision of services.


• Ability to recognize when a matter falls outside the scope of EBS Program benefits and determine appropriate referrals or other available resources.


• Ability to negotiate and resolve issues through administrative advocacy while considering customer self-determination, informed consent, professional boundaries, and applicable program requirements.


• Ability to think conceptually and understand relationships between ideas, rules, facts, and circumstances that are not immediately obvious.

PHYSICAL AND WORK ENVIRONMENT: 
The physical and work environment characteristics described in this description are representative of those an employee encounters while performing the essential functions of this job.  Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions or as otherwise required by law.  Employees needing reasonable accommodation should discuss the request with the employee’s supervisor.   

  
PHYSICAL REQUIREMENTS 

• Work may involve the occasional exertion of up to 25 pounds of force; work regularly involves standing and performing fine motor skills and repetitive motions, and occasionally involves walking, stooping, kneeling, crouching or crawling and reaching above shoulder level or below the waist. 


• Visual ability to perform tasks such as reading documents, operating vehicles, using computer screens, or working with detailed data. 


• Ability to communicate and exchange information effectively with others, with or without reasonable accommodation. 

WORK ENVIRONMENT: 

• Work is primarily performed in an office setting and through telephone, virtual, email, and written communication.


• Regular local travel may be required to provide services in customers' homes and at community sites and to conduct outreach, education, training, or representation activities.


• Work may also occur at government offices, administrative hearings, health care settings, residential facilities, or other locations appropriate to customer service needs.


• Travel and work assignments may involve exposure to inclement weather conditions, unsanitary conditions in homes, communicable illnesses and diseases, and unsafe environments.


• The position may require dealing with persons who are hostile, aggressive, abusive, or violent, which may present threatening conditions.

MINIMUM QUALIFICATIONS:
 
EDUCATION AND EXPERIENCE REQUIREMENTS 

ADRC Elder Benefit Specialist I 

• Bachelor's degree in a health or human services related field. 


• Three (3) years’ experience working with one or more of the client populations served by the ADRC.


• Experience working with Medicare, Medicaid, advocacy, Social Security and/or consumer rights desired.


• Must complete EBS program orientation and initial training and become a certified SHIP counselor within 18 months of hire; must maintain required EBS training participation and SHIP certification thereafter.


• Appointment is conditional upon successful completion of a caregiver and criminal background check.

ADRC Elder Benefit Specialist II 

• Must meet all education, experience, training, and certification requirements of an ADRC Elder Benefit Specialist I, including completion of EBS initial training and attainment and maintenance of SHIP counselor certification.


• Minimum of three (3) years’ experience as an ADRC Elder Benefit Specialist I with St. Croix County or in a substantially similar EBS or benefits-advocacy role with another organization. Experience must demonstrate mastery of EBS program content, case and caseload management, advocacy, services, resources, and reporting requirements, as well as the ability to enhance program quality and service delivery.

Starting pay is determined within the expected hiring range based on qualifications, directly related experience, and internal equity. Employees may advance through the full salary range in accordance with County policy.