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

State of South Carolina; Columbia (SC); On-site; USD 42,000 - 62,000; Full time

Benefits offered by this job

Health insurance

Vacation leave

Sick leave

Paid holidays

State retirement plan

Job summary

South Carolina Department of Health and Human Services seeks a Program Coordinator I (MAGI) to promote its mission in Eligibility Appeals & Quality. The in-office role in Richland County requires analyzing case records, guiding corrective actions, and processing appeals with timely responses to Fair Hearing requests.

The role includes representing the department in hearings, coordinating with policy teams, and staying abreast of Medicaid eligibility policies. Statewide travel is required.

Qualifications

• High school diploma required.
• Knowledge of MAGI eligibility and the appeals process preferred.
• Experience with Medicaid policies and procedures is a plus.

Responsibilities

• Analyze case information to verify eligibility decisions.
• Prepare and send Appeals Packets per policy.
• Attend hearings to represent the department, with statewide travel.
• Coordinate with Eligibility Policy/Quality teams for relevant information.
• Maintain timely responses to requests for Fair Hearing.

Skills

Case analysis

Policy knowledge

Communication skills

Travel readiness

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 is 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?

We are looking for a 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.

• 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.

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 high school dipolma 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.

• 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.