Program Coordinator I (EEMS Respondent Coordinator) / 60020388RP

State-of-South-Carolina; South Carolina; Sur place; USD 42 000 - 56 000; Plein temps

Avantages offerts par ce poste

Health Insurance

Dental Insurance

Vision Insurance

Long Term Disability

Life Insurance

Paid time off

Holidays

Résumé du poste

The South Carolina Department of Health and Human Services is hiring a Program Coordinator I (EEMS Respondent Coordinator) to promote the agency's mission. Under limited supervision, you will process MAGI as well as Non-MAGI and Specialty appeal requests and represent the agency in hearings and appeals.

This in-office role requires knowledge of Medicaid policies, strong communication, and the ability to gather and analyze case information, ensuring timely responses and accurate eligibility

Qualifications

• High school diploma and relevant program experience.
• Preferred knowledge of MAGI Medicaid eligibility and SCDHHS appeal process.
• Knowledge of Medicaid Eligibility Policies and Procedures.

Responsabilités

• Analyze case information to determine accuracy of eligibility decisions.
• Prepare and send Appeals Packets to Division of Appeals and Hearings and to petitioners.
• Attend hearings to represent the Department and present evidence for eligibility decisions.
• Follow Medicaid policies and timeliness procedures in responses to applicants/petitioners.

Connaissances

Communication skills

Attention to detail

Judgment and discretion

Oral and written communication

Formation

High school diploma

Outils

MEDS

CURAM

Mobius

OnBase

MMIS

CGIS

Description du poste

*This position is a re-post. Previous applicants do not need to re-apply.*

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

Eligibility Determinations & Appeals, Richland County.

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

Are you the One?

We are looking for a Program Coordinator I (EEMS Respondent Coordinator)who promotes the mission and values of SCDHHS. Under limited supervision, serves as MAGI Eligibility Respondent Coordinator and is cross trained to process Non-MAGI and Specialty appeal requests. Will represent the agency in both formal and informal hearings and appeals processes. Reviews case records to ensure the Medicaid decision under appeal was accurately determined based upon the correct application of Medicaid policies and procedures. Ensures an accurate and timely response to applicant/petitioner requests for Fair Hearing.

• Analyzes case information to determine the accuracy of the eligibility decision. Reviews case findings and ensures the receipt of a request for Fair Hearing. Reviews case file for documentation of legal representation if petitioner is someone other than the applicant/beneficiary. Provides information regarding case decisions and guidance for corrective action to eligibility workers and eligibility supervisors when eligibility determinations are inaccurate. Identifies error trends and reports findings to direct supervisor.
• When applicable, gathers and/or analyzes additional information provided by the petitioner, Eligibility Policy Team and/or Eligibility Quality Team to determine relevancy to the proposed action and complete an eligibility decision utilizing this information. Prepares and sends the Appeals Packet to the Division of Appeals and Hearings and to the petitioner per policy. Responds to any interlocutory, prehearing orders or Orders to Produce received from the Division of Appeals and Hearings within the required timeframes.
• Stays abreast of all current SCDHHS policy and procedures pertaining to Medicaid eligibility and the appeals process.
• Attends hearings to represent the Department of Health and Human Services and present evidence to support the eligibility decision.
• Follows the directives in the Final Administrative Decision and/or Order of Remand when issued by the Division of Appeals and Hearings. When ordered, make a new eligibility determination and issue a new Notice of Action to the applicant/beneficiary. Follows Medicaid policies and timeliness procedures to respond to the applicant/beneficiary/petitioner if an appeal is filed based on a new decision. Takes necessary actions to determine/reinstate eligibility when the previous decision was reversed.
• Complete other job duties as assigned. May require performing tasks across the team or other business units within the agency.

Benefits

• 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 relevant program experience.

Preferred: Knowledge of Medicaid (MAGI) eligibility and the SCDHHS appeal process.

Additional Requirements

• Sitting or standing for long periods of time.
• Overtime and/or weekend work with Deputy approval.
• Lifting requirements: 20 lbs.
• Occasional overnight travel.
• Requires holder to drive routinely.
• Valid driver's license.
• In-office role.

• Knowledge of SCDHHS Medicaid Eligibility Policies and Procedures as well as general knowledge of applicable state and federal regulations.
• Ability to exercise judgment and discretion.
• Must have strong oral and written communication skills and be able to communicate effectively.
• Candidate must establish and maintain professional interaction with agency staff, service provider staff and Medicaid applicants/beneficiaries/petitioners.
• Must be able to gather information in a timely and accurate manner and demonstrate attention to detail.
• Ability to interpret and apply laws, regulations, policies and procedures.
• Knowledge of SCDHHS Medicaid Eligibility systems such as MEDS, CURAM, Mobius, OnBase, MMIS, CGIS is preferred.
• Statewide travel to hearings is required.

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.