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#22-004435-0008
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

Explain your experience in 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

Do you have supervisory experience? If yes, please describe in detail and include name of employer(s) where you gained this experience, dates of employment, and relevant job duties. If no, please enter N/A.

4

Describe your experience utilizing platforms such as the Maryland Medicaid Information System (MMIS), the Maryland Heath Connection (HBX) worker portal, and/or the Eligibility & Enrollment System (E&E).

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

5

Describe your experience working with diverse populations.

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

6

Bilingual applicants are encouraged to apply.  Are you able to speak, read and write in both Spanish and English? 

Yes No
7

Explain your experience providing bilingual Spanish services to customers. Please include name of employer, job title, dates of employment, and hours worked per week. If you do not have this type of experience, please write N/A


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