Program Coordinator I (EEMS Respondent Coordinator (MAGI)) / 60020763RP

State of South Carolina; Columbia (SC); On-site; USD 48,000 - 62,000; Full time

Benefits offered by this job

Health insurance

Dental insurance

Vision insurance

Long term disability

Life insurance

15 days annual leave

Job summary

The State of South Carolina's Department of Health and Human Services seeks a Program Coordinator I (EEMS Respondent Coordinator - MAGI) to promote the agency's mission. Located in Richland County, this in-office role handles MAGI eligibility appeals, cross-trains on Specialty appeals, and represents the agency in hearings with timely case responses.

Responsibilities include analyzing eligibility decisions, preparing appeal packets, and staying current with Medicaid policies.

Qualifications

• High school diploma and relevant program experience.
• Familiarity with Medicaid eligibility policies preferred.
• Knowledge of MAGI eligibility and appeals processes preferred.

Responsibilities

• Analyzes case information to determine the accuracy of the eligibility decision.
• Prepares and sends the Appeals Packet to the Division of Appeals and Hearings per policy.
• Responds to interlocutory orders or Orders to Produce within required timeframes.
• Stays abreast of current SCDHHS policy and procedures pertaining to Medicaid eligibility and the appeals process.
• Attends hearings to represent the Department and statewide travel is required.
• Performs other duties as assigned across the team or other units.

Skills

Oral communication

Written communication

Attention to detail

Analytical thinking

Education

High school diploma

Tools

CURAM

OnBase

MMIS

CGIS

Job description

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 Eligibility Appeals & Quality, Richland County.

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

Are you the One?

Program Coordinator I (EEMS Respondent Coordinator (MAGI)) who will promote the mission and values of SCDHHS. Under limited supervision, serves as a MAGI Eligibility Respondent Coordinator and will be cross trained to process Specialty appeals. 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.

Job Responsibilities

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

• Analyzes case information to determine the accuracy of the eligibility decision. Reviews case findings and ensures 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.
• Attend hearings to represent the Department of Health and Human Services and present evidence to support the eligibility decision. Statewide travel to hearings is required.
• 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

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 relevant program experience.

PREFERRED: Knowledge of SCDHHS Medicaid Eligibility Policies and Procedures as well as general knowledge of applicable state and federal regulations. Knowledge of Medicaid (MAGI eligibility) and the SCDHHS appeal process is preferred. Knowledge of SCDHHS Medicaid Eligibility systems such as CURAM, OnBase, MMIS, and CGIS are preferred.

Additional Requirements

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

Preferred Qualifications

• Ability to exercise judgment and discretion.
• Must have strong oral and written communication skills and be able to communicate effectively.
• The 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.
• 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.

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.