Eligibility Specialist II (LTCW) / 60013962

State of South Carolina; South Carolina; On-site; USD 38,000 - 52,000; Full time

Job summary

The State of South Carolina is seeking an Eligibility Specialist II (LTCW) to determine and re-determine Medicaid eligibility in an in-office setting. You will gather and review documentation from applicants and third parties, following policies to make accurate determinations and changes.

You will document all steps clearly, communicate with beneficiaries and colleagues, and participate in required trainings. Overtime and occasional travel may be required.

Qualifications

• High school diploma or equivalent required.
• Experience in customer services, social services, human services, and/or Medicaid processing.
• Bachelor's degree may substitute for required program experience.
• Occasional overnight travel and ability to work overtime/weekends with approval.

Responsibilities

• Determine and re-determine Medicaid eligibility according to policies and procedures.
• Collect and evaluate documentation from applicants and third parties.
• Perform follow-up to obtain outstanding information in a timely manner.
• Document notes and steps clearly for review and hand-off in systems.
• Maintain professional communication with beneficiaries and coworkers.

Skills

Customer service

English proficiency

Communication skills

Documentation

Mathematical computations

Education

High school diploma

Bachelor's degree substitution for experience

Tools

Microsoft Office

Internet browsers

Job description

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

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.

Eligibility Specialist II (LTCW)

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.

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 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.

• 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.