Eligibility Coordinator I (Non-MAGI)/ 60014328

State of South Carolina; Columbia (SC); On-site; USD 38,000 - 48,000; Full time

Job summary

The State of South Carolina Department of Health and Human Services seeks an Eligibility Coordinator I for Specialty Unit A in Richland County. This in-office role requires determining and redetermining Medicaid eligibility for TEFRA, BCCP, TB, and PCSC Waiver cases.

You will collect and analyze information, communicate with DHEC and other agencies, and document steps clearly in the system while protecting PHI/PII.

Qualifications

• Must have high school diploma; relevant experience in customer services, social services, human services, and/or Medicaid processing.
• Two (2) years of experience with Medicaid Eligibility policy and procedures, and the MEDS or Curam system is preferred.
• In-office role with on-site requirements; occasional travel and driving required.

Responsibilities

• Determine/re-determin e Medicaid eligibility and changes of circumstance for applicants and beneficiaries.
• Collect, evaluate, and document information from applicants/beneficiaries and third parties with minimal burden to the client.
• Coordinate with DHEC, DDSN, LTL, and other agencies as needed for determinations and level of care decisions.
• Maintain proper documentation and secure PHI/PII in systems of record; escalate issues per policy.

Skills

Medicaid eligibility

Public benefits processing

PHI/PII handling

Communication skills

Education

High school diploma

Bachelor's degree substitution for experience

Job description

The Agency's mission is to be boldly innovative in improving the health and quality of life for South Carolinians.

This position is located in Specialty Unit A, Richland County.

This is an in-office role and not a telecommute or remote position.

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.

The South Carolina Department of Health and Human Services offers an exceptional benefits package for FTE and TGE positions that includes:

• 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.

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

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

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.