Eligibility Coordinator I (Non-MAGI) / 61061999

State of South Carolina; Columbia (SC); On-site; USD 42,000 - 58,000; Full time

Benefits offered by this job

Health insurance

15 days annual leave

15 days sick leave

13 paid holidays

State Retirement Plan

Job summary

The State of South Carolina is seeking an Eligibility Coordinator I (Non-MAGI) to determine and re-determine Medicaid eligibility for TEFRA, BCCP, TB, and PCSC Waiver in the Specialty Unit A, Richland County. This in-office role requires strong customer service and compliance with privacy laws.

Ideal candidates will have knowledge of MEDS/Curam, good communication skills, and the ability to manage documentation and deadlines while coordinating with other agencies.

Qualifications

• High school diploma and relevant program experience.
• Bachelor's degree may be substituted for the required program experience.
• Preferred: Two years of Medicaid eligibility experience; MEDS or Curam familiarity.
• Valid driver's license; occasional travel.
• In-office role in Richland County, SC.

Responsibilities

• Determine/re-determine Medicaid eligibility for TEFRA, BCCP, TB, and PCSC Waiver.
• Collect and analyze information with minimal burden to the applicant while following policies.
• Ensure timely determinations with proper documentation and escalation as needed.
• Provide technical assistance and/or training to staff and external agencies.

Skills

Medicaid policy knowledge

Eligibility determinations

Documentation & records management

Communication skills

Confidentiality

Time management

Customer service

Education

High school diploma

Bachelor's degree substitution allowed

Medicaid eligibility experience

Tools

MEDS

Curam

Windows/Word/Excel

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 inSpecialty 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 (Non-MAGI)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.
• Maintains a professional demeanor and communication style, ensuring that communication and interactions with coworkers, supervisors, and beneficiaries is clear, polite, and concise. Participates in customer service and privacy training and ensures that confidential or private information is maintained in accordance with State and Federal laws articulated through departmental policies and training. There should be no more than two (2) valid customer service complaints monthly.
• Attends all mandatory meetings, trainings, and events as directed by supervisory staff and agency leadership. Maintains awareness of and complies with all agency policies, to include privacy, confidentiality, standards of conduct, performance, leave and compensation, vehicle use and travel, and financial controls. Maintains appropriate certification and training to perform emergency management evacuation and shelter duties as necessary. Performs other duties as assigned by supervisory staff and agency leadership.

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 program experience.

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

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

Additional Requirements:

• Valid driver's license.
• 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.
• In-office role.

• Considerable knowledge of Medicaid eligibility policies and procedures and the Medicaid Determination Eligibility System (MEDS) or Curam.
• Effective communication and organizational skills.
• Knowledge of Windows, Microsoft Word and Excel.
• Should exemplify professionalism at all times and contribute to good teamwork practices and overall success of the Division.
• Should be able to identify a need, make decisions, and respond appropriately.
• Ability to maintain confidentiality.

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.