Eligibility Specialist II (Non-MAGI) / 61096805

State of South Carolina; Columbia (SC); On-site; USD 38,000 - 52,000; Full time

Benefits offered by this job

Health and dental insurance

15 days annual leave

15 days sick leave

13 paid holidays

State retirement plan

Job summary

The State of South Carolina, Department of Health and Human Services, seeks an Eligibility Specialist II (Non-MAGI) to determine Medicaid eligibility and process documentation in Lee County. This in-office role requires collecting and evaluating documents and applying state policies to make timely determinations.

Responsibilities include following escalation procedures, maintaining clear notes, and ensuring privacy and confidentiality in all interactions with applicants and beneficiaries.

Qualifications

• 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.

Responsibilities

• Determines or redetermines Medicaid eligibility according to policies and procedures.
• Collects and evaluates documentation from applicants to determine eligibility for the program.
• Completes eligibility determinations, reviews, and changes in the systems of record with accurate documentation.

Skills

English communication

Customer service

Mathematical computations

Education

High school diploma

Bachelor's degree may be substituted

Tools

Microsoft Office

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 Localized Eligibility Processing (LEP), Lee County.

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

This position is an Eligibility Specialist II (Non-MAGI) who determines/re-determines 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

• Overtime and/or weekend work with Deputy approval.
• Sitting or standing for long periods of time.
• Lifting requirements: 20 lbs.
• Occasional overnight travel.
• 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.