Internal Only: Program Coordinator II (Member Services Liaison) / 60018808

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

Benefits offered by this job

Health insurance

Dental insurance

Vision insurance

Long Term Disability

Life Insurance

15 days annual leave

15 days sick leave

13 paid holidays

State retirement plan

Job summary

South Carolina Department of Health and Human Services is seeking a Member Services Liaison to oversee the Member Contact Center (MCC) monitoring and assist with escalations for Medicaid applicants, beneficiaries, and providers. This in-office role requires driving to MCC sites for onsite inspections and attending scheduled meetings.

The candidate will analyze trends affecting first call resolution, document findings, and communicate with Contract Manager to improve contractor performance.

Qualifications

• Bachelor’s degree required.
• One (1) year of experience with Medicaid.

Responsibilities

• On-site monitoring by listening to live/recorded MCC calls and documenting findings.
• Report deficiencies to Contract Manager and identify training needs for MCC staff.
• Escalate eligibility calls to EEMS and other agency departments as needed; assist with resolutions for member concerns.
• Maintain knowledge of Medicaid policies, MMIS, CURAM, OnBase and agency procedures; research member issues as needed.
• Participate as a project team member to support bureau priorities and assist with other teams as assigned.
• Attend professional development opportunities and apply new skills to improve effectiveness.

Education

Bachelor’s degree

Job description

***Internal Posting- Only current SCDHHS Employees will be considered.***

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

This position is located in the Bureau of Provider & Support Services, Richland County.

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

Are you the One? We are looking for a Member Services Liaison who will work as a liaison within the Bureau of Provider and Support Services Member Services Department to assist with the oversite of the Member Contact Center (MCC) monitoring task. This requires driving to the MCC for onsite visits to inspect for contractual requirements of the physical operation, listening to live and recorded incoming phone calls, and attend meetings as scheduled. Assist with the escalation process regarding Medicaid applicants, beneficiaries, providers, and other agency stakeholders as part of the Member Services team. Participate in bureau initiatives to improve efficiency as it pertains to supporting members and complaints that come through the MCC. Analize trends that may adversely affect member’s first call resolution. Provide insight into when issues arise regarding contract compliance and consumer complaints.

• On-site and off-site monitoring by actively listening and documenting random sampled telephone general inquiry calls that are live and/or have been recorded by the MCC. Listen and document random sampled telephone application calls that are live and/or have been recorded by the MCC and report the deficiencies to the Contract Manager. Identify any needs where MCC staff may need additional training and/or guidance and report the deficiencies to the Contract Manager. Keep record of calls listened to and submit weekly and monthly reports of number of calls and overall findings to Contract Monitor.
• Working in conjunction with the Contract Monitor, escalated eligibility calls to EEMS and other agency departments as needed. When appropriate (i.e., for calls not needing eligibility escalations) contact members regarding complaints received through the MCC and assist with resolution.
• Maintain knowledge of current and revised Medicaid Policy and Procedures, Medicaid Management Information System (MMIS), CURAM, OnBase and Agency policies and procedures. Stay abreast of internal changes as it pertains to members and applicants to ensure appropriate assistance is provided. Research member issues and complaints as a team member in BOPSS.
• Participate as a project team member, as needed, or assigned, to support reference administration interests and bureau priorities aligned with strategic goals and agency mission and objectives. Other duties, as assigned, i.e., mentor to new hires, assist with bureau improvement efforts (not a formal project) and to assist other teams within and outside of our bureau.
• Attends and participates in relevant opportunities for professional development and training. Demonstrates utilization and application of new skills learned to improve effectiveness and efficiency within assigned responsibilities.
• In coordination with the Member Services Program Manager 1 and the MCC Grants Administrator/MCC Contract Monitor, assist with identifying trends and conduct research on eligibility issues, claims issues, and other escalations that come in via the MCC to provide resolution to the member’s concern. Document in Service Manager.

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 bachelor’s degree and one (1 )year of experience with Medicaid.

An equivalent combination of education and experience may be considered with prior State Human Resources approval.

All degrees must be from a college or higher education institution recognized by the U.S. Department of Education & Council for Higher Education Accreditation (CHEA).

Additional Requirements:

• Occasional overnight travel
• Requires holder to drive routinely
• In-office Role
• Valid driver’s license
• Sitting or standing for long periods of time.
• Lifting requirements: 20 lbs.
• In-office Role

• Computer skills to include Word, Excel and Power Point.
• Organizational skills and ability to work in a self-directed manner, using good judgement and own discretion.
• Excellent verbal and written communication skills.

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.