Eligibility Coordinator I (Non-MAGI)/ 60014328

About the Department

Are you the One? We are looking for an Eligibility Coordinator I, who will determine/re-determine Medicaid eligibility assigned to the Specialty Unit included but not limited to TEFRA, Breast Cervical Cancer Program (BCCP), Tuberculosis, and the Palmetto Coordinated System of Care (PCSC) Waiver. Demonstrates positive, cooperative and professional relationships and customer service with staff, co-workers, customers, providers, administrators, the general public, and all stakeholders.  Must exhibit dependability/reliability/time management by reporting to work on time, by meeting work schedules & deadlines and completing job tasks effectively and efficiently.

• Uses various information sources, electronic tools, and systems provided by the Department to collect, assemble, evaluate, and act upon information provided by applicant/beneficiaries and third parties to make timely eligibility determinations, reviews, and changes of circumstance.  Follows policies and procedures for the collection and analysis of applications and documentation and collects additional information for beneficiaries as necessary with the least burden to the applicant/beneficiary as possible. This includes but not limited to commination with DHEC for BCCP recommendations and DDSN/LTL for Level of Care determinations for TEFRA applications.  Performs follow-up activities in an efficient and effective manner, using the communication method most appropriate for obtaining outstanding information in a timely manner. Documents all notes and steps clearly and completely for review and hand-off to other specialists. 
• In addition to meeting minimum standards for timely determinations in accordance with the Department's EPSM and serving as a liaison to other government agencies specialist is responsible for maintaining time limited specialized cases expedited to the unit.
• Demonstrates proficiency in utilizing all processes, policies, procedures, and system updates to ensure that all
  eligibility determinations, reviews, and changes are completed accurately with satisfactory documentation. Makes accurate determinations of eligibility based on the rules and standards detailed by the Department and defined in written performance standards. Resolves discrepancies in case determinations or documentation a timely manner. Follows appropriate escalation processes as outlined in eligibility process documentation. Labels all documentation, records decision and notes clearly and accurately in the appropriate systems of record.
• Provides technical assistance and/or training to staff, management, public and outside agencies, such as DDSN, DHEC, and  Family Services and Family Connections.
• Eligibility Specialist displays professional demeanor and behavior in appearance, communication, and performance. Maintains a secure workspace ensuring protected health information (PHI) and personally identifiable information (PII) and are protected. Does not breach or otherwise disclose confidential agency, beneficiary, or personnel information and uses appropriate and secured methods of communicating confidential information. Department does not receive substantiated complaints from co-workers or beneficiaries about Eligibility Specialist’s demeanor or professionalism.
  
  

• Health, Dental, Vision, Long Term Disability, and Life Insurance for Employee, Spouse, and Children.
• 15 days annual (vacation) leave per year.
• 15 days sick leave per year.
• 13 paid holidays.
• State Retirement Plan and Deferred Compensation Programs.

Position Duties

 A high school diploma and relevant experience in customer services, social services, human services, and/or Medicaid processing. 

A bachelor’s degree may be substituted for the required program experience.  

Additional Requirements:

• Requires holder to drive routinely.
• Occasional overnight travel
• Overtime and/or weekend work with Deputy approval.
• Sitting or standing for long periods of time.
• Lifting requirements: 20 lbs.
• Valid driver’s license
• In-office Role

Minimum Qualifications

• Two (2) years of experience with Medicaid Eligibility policy and procedures, and the Medicaid Determination Eligibility System (MEDS) or Curam preferred.

Other Qualifications

Please complete the State application to include all current and previous work history and education. A resume will not be accepted nor reviewed to determine if an applicant has met the qualifications for the position. Supplemental questions are considered part of your official application for qualification purposes. All applicants must apply online. All correspondence from the Office of Human Resources will be through electronic mail.

The South Carolina Department of Health and Human Services is committed to providing equal employment opportunities to all applicants and does not discriminate on the basis of race, color, religion, sex (including pregnancy, childbirth or related medical conditions, including, but not limited, to lactation), national origin, age (40 or older), disability or genetic information.

Benefits

Supplemental Questions

Required Question

Agency Information

EmployerState of South CarolinaAgency Department of Health and Human Services Address 1801 Main Street, Suite 224

Columbia, South Carolina, 29201 Phone803-898-2670