Eligibility Specialist II (LTCW) / 60013962

State of South Carolina; Columbia (SC); On-site; USD 40,000 - 55,000; Full time

Benefits offered by this job

Health, Dental, Vision Insurance

Long Term Disability Insurance

Life Insurance

State Retirement Plan

Deferred Compensation Programs

Paid time off (15 days) and holidays (

Job summary

The State of South Carolina, Department of Health and Human Services, seeks an Eligibility Specialist II (LTCW) to determine and review Medicaid eligibility for Region 1 Long Term Care Outstations. This in-office role requires handling applicant documents, following policy, and ensuring timely determinations with accurate records.

The position emphasizes customer service, privacy compliance, and collaboration with team members to support beneficiaries and maintain quality service standards.

Qualifications

• High school diploma and experience in customer services, social services, human services, and/or Medicaid processing.
• A bachelor's degree may be substituted for the required program experience.

Responsibilities

• Determine/re-determine Medicaid eligibility according to policies and procedures.
• Collect and evaluate documentation from applicants to determine eligibility.
• Complete eligibility determinations, reviews, and changes with accurate documentation.
• Follow up to obtain outstanding information and document all steps clearly in systems.
• Maintain professional communication and comply with privacy and confidentiality policies.

Skills

Customer service

English proficiency

Mathematical computations

Education

High school diploma

Bachelor's degree substitution allowed

Tools

Microsoft Office

Internet browsers

Job description

Job Responsibilities

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

This position is located in Long Term Care (LTC) Outstations, Region 1 Counties, (Abbeville, Anderson, Cherokee, Edgefield, Greenville, Greenwood, Laurens, McCormick, Oconee, Pickens, Saluda, Spartanburg, Union).

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

Are you the One? We are looking for an Eligibility Specialist II (LTCW) who will determine/re-determine Medicaid eligibility according to Medicaid policies and procedures. This position collects and evaluates documentation from applicants to determine individual and family eligibility for the program. Eligibility Specialists complete all assigned eligibility determinations, reviews, and changes in an accurate and timely manner.

• 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. 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.
• 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.
• Maintains a professional demeanor and communication style, ensuring that communication and interactions with co-workers, 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 law as articulated through departmental policies and training.
• 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.

Benefits

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.

Minimum And Additional Requirements

A high school diploma and 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

• 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.

Preferred Qualifications

• Eligibility Specialists must have a familiarity with computers, standard Microsoft Office software, internet browsers, and the ability to read, write, and speak English in a clear and concise manner.
• Must be able to perform basic mathematical computations.
• Eligibility Specialists must be able to work in a professional office environment with a diverse group of teammates and provide excellent customer service either face to face, telephonically or through written communication.
• Eligibility Specialists must be able to learn, retain, and apply information about federal rules and standards for processing Medicaid eligibility determinations.
• Specialists must maintain productive workspaces and must perform tasks in an effective manner to ensure the completeness, accuracy, and timeliness of eligibility determinations.

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 For State Employees

The state of South Carolina offers eligible employees generous benefits, including health and dental insurance; retirement and savings plan options; and paid vacation and sick leave. Plus, work-life balance programs such as telecommuting and flexible work schedules are available to employees of some state agencies.

Insurance Benefits

Eligible employees may enroll in health insurance, which includes prescription coverage and wellness benefits. Other available insurance benefits include dental, vision, term life insurance, long term disability and flexible spending accounts for health and child care expenses.

Retirement Benefits

State employees are also offered retirement plan options, including defined benefit and defined contribution plans. Additionally, eligible employees may elect to participate in the South Carolina Deferred Compensation Program, which is a voluntary, supplemental retirement savings plan offering 401(k) and 457 plan options.

Workplace Benefits

State employees may also be eligible for other benefits, including tuition assistance; holiday, annual and sick leave; and discounts on purchases, travel and more.

Note:

The benefits above are available to most state employees, with the exception of those in temporary positions. Employees in temporary grant and time-limited positions may be eligible for all, some or none of these benefits as benefits are associated with each position type. For these positions, contact the hiring agency to determine what benefits may be available.