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#24-004435-0001
Supplemental Questionnaire

Last Name
First Name

 

**Please note that your answers on the supplemental questionnaire must correspond to the information provided on your application to receive credit. Applications that do not include a completed supplemental questionnaire will be considered incomplete and may be subject to disapproval.**

 


1.

Describe your clerical experience applying policies in a medical care, health insurance or Federal or State entitlement program.

Please include name of employer, job title, dates of employment, and hours worked per week.  If you do not possess experience in this area, put N/A in the box below.

2.

Describe your experience applying, interpreting and processing program specific information, policies, regulations and guidelines in a medical care program.

With your description, include name of employer, job title, dates of employment, and hours worked per week for each relevant position.  If you do not have this experience, put N/A in the box below.

3.

Describe your knowledge of and/or experience with the Medicaid/HealthChoice Program policies, including eligibility requirements, benefits, services, navigation, complaint process, and related services.

 

This experience should be included on your application, including hours and dates worked. If you do not possess this type of experience, please put N/A in the text box.

4.

Describe your experience with interpreting and applying a variety of laws, rules, regulations, standards, and procedures.

This experience should be included on your application, including hours and dates worked. If you do not possess this type of experience, please put N/A in the text box.

5.

Describe your experience as a Medical Assistance Eligibility and Enrollment case manager.

 

This experience should be included on your application, including hours and dates worked. If you do not possess this type of experience, please put N/A in the text box.


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