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

State-of-South-Carolina; South Carolina; On-site; USD 42,000 - 62,000; Full time

Benefits offered by this job

Health, Dental, Vision

Retirement Plan

Paid holidays

Sick & vacation leave

Job summary

South Carolina Department of Health and Human Services is seeking a Member Services Liaison to monitor the Member Contact Center (MCC) calls on-site, document findings, and escalate eligibility issues as needed. The role supports the Bureau of Provider & Support Services in ensuring contract compliance and responsive member service.

The position requires a bachelor’s degree and Medicaid experience, along with strong written and verbal communication, and the ability to work independently in an

Qualifications

• Bachelor’s degree required
• One year of experience with Medicaid
• Excellent verbal and written communication skills
• Computer skills including Word, Excel and PowerPoint
• Occasional travel and valid driver’s license

Responsibilities

• On-site monitoring of the Member Contact Center (MCC) calls (live or recorded).
• Document deficiencies and report to Contract Manager.
• Escalate eligibility calls as needed and assist with resolutions.
• Maintain knowledge of Medicaid policies, MMIS, CURAM, OnBase, and agency procedures.
• Participate in project teams and bureau improvement efforts.

Skills

Verbal communication

Written communication

Organizational skills

Self-directed work style

Education

Bachelor’s degree

Tools

Word

Excel

PowerPoint

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.

Member Services Liaison

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.

Please complete the State application to include all current and previous work history and education.

A resume will not be accepted nor reviewed to determine if an applicant has met the qualifications for the position. Supplemental questions are considered part of your official application for qualification purposes.

All applicants must apply online. All correspondence from the Office of Human Resources will be through electronic mail.

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.