Program Coordinator I (EEMS Respondent Coordinator (LTC) / 60020513RP

State of South Carolina; Columbia (SC); On-site; USD 42,000 - 66,000; Full time

Job summary

The State of South Carolina seeks an EEMS Respondent Coordinator (LTC) to promote the agency's mission and handle fair hearings and appeals. This in-office role requires presenting evidence, reviewing records, and ensuring timely responses according to Medicaid policies.

Under limited supervision, you will analyze case information, communicate decisions clearly, and provide guidance to staff on corrective actions when eligibility determinations are inaccurate.

Qualifications

• High school diploma and applicable professional experience in social services, administration, or related fields.
• Knowledge of Medicaid LTC eligibility and the SCDHHS appeals process preferred.
• Strong oral and written communication skills and ability to communicate effectively.
• Ability to interpret and apply laws, regulations, policies and procedures.

Responsibilities

• Represent the agency in formal and informal hearings and appeals.
• Review case records to ensure Medicaid decisions are accurate.
• Prepare and send Appeals Packets to the Division of Appeals and Hearings and petitioner.
• Attend hearings to present evidence and support the eligibility decision.
• Follow Medicaid policies and timeliness procedures in response to requests.

Skills

Oral communication

Written communication

Attention to detail

Judgment & discretion

Interpersonal skills

Time management

Policy interpretation

Medicaid knowledge

Education

High school diploma

Tools

CURAM

OnBase

MMIS

CGIS

Job description

*This position is a repost. Previous applicants do not need to reapply.*

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

This is position is located on the Office of Eligibility Appeals & Quality, Richland County.

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

Are you the One?

We are looking for a EEMS Respondent Coordinator (LTC),who will promote the mission and values of SCDHHS. Under limited supervision. 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.

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.

High school diploma and relevant professional experience in social service programs, business administration, general administrative management or relevant program experience.

Knowledge of Medicaid (LTC) eligibility and the SCDHHS appeal process is preferred.

Additional Requirements:

• Occasional overnight travel.
• Requires holder to drive routinely.
• Overtime and/or weekend work with Deputy approval.
• Sitting or standing for long periods of time.
• Lifting requirements: 20 lbs.
• 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 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 CURAM, OnBase, MMIS, and CGIS is preferred.
• Relevant program experience:
  • Knowledge of Medicaid LTC eligibility.
  • Knowledge of appeal and hearings or court experience.
  • Strong oral 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.