Eligibility Specialist II (LTCW) / 61070519

State of South Carolina; Columbia (SC); On-site; USD 42,000 - 56,000; Full time

Benefits offered by this job

Health, Dental, Vision Insurance

15 days annual leave

State Retirement Plan

Job summary

South Carolina Department of Health and Human Services seeks an Eligibility Specialist II (LTCW) to be the front-line contact for Medicaid eligibility. The role collects and evaluates documentation to determine eligibility, performs determinations and changes, and serves as a subject matter expert for the team.

The position requires in-office presence, adherence to privacy standards, and close collaboration with supervisors and beneficiaries.

Qualifications

• High school diploma and experience in customer services, social services, human services, and/or Medicaid processing.
• Bachelor's degree may be substituted for the required program experience.
• Familiarity with computers and standard Microsoft Office software; ability to read, write, and speak English clearly.
• Must be able to perform basic mathematical computations.

Responsibilities

• Collect, assemble, evaluate, and act upon information provided by applicants/beneficiaries and third parties to determine eligibility.
• Conduct timely determinations, reviews, and changes of circumstance according to policies.
• Document all notes and steps clearly in the systems of record.
• Escalate and resolve discrepancies using defined processes.
• Maintain professional communication with coworkers and beneficiaries and ensure privacy.

Skills

Customer service

Communication

Microsoft Office

English proficiency

Education

High school diploma

Bachelor's degree substitution allowed

Tools

Internet browsers

Job description

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 Eligibility, Enrollment and Member Service (EEMS) Processing Centers, 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 Specialist II (LTCW) whois the front-line of beneficiary access to the Medicaid program. This position collects and evaluates documentation from applicants to determine individual and family eligibility for the program. Eligibility Specialists ensure the integrity of the Medicaid program by completing all eligibility determinations, reviews, and eligibility changes in an accurate and timely manner. In addition to meeting minimum standards for timely determinations in accordance with the Department’s EPSM, serves as a subject matter expert and first tier escalation authority for individuals on their team.

• 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.