- Uses various information sources, electronic tools, and systems provided by the Department to collect, assemble, evaluate, and act upon information provided by applicant/beneficiaries and third parties to make timely eligibility determinations, reviews, and changes of circumstance. Follows policies and procedures for the collection and analysis of applications and documentation and collects additional information for beneficiaries as necessary with the least burden to the applicant/beneficiary as possible. This includes but not limited to commination with DHEC for BCCP recommendations and DDSN/LTL for Level of Care determinations for TEFRA applications. Performs follow-up activities in an efficient and effective manner, using the communication method most appropriate for obtaining outstanding information in a timely manner. Documents all notes and steps clearly and completely for review and hand-off to other specialists.
- In addition to meeting minimum standards for timely determinations in accordance with the Department's EPSM and serving as a liaison to other government agencies specialist is responsible for maintaining time limited specialized cases expedited to the unit.
- Demonstrates proficiency in utilizing all processes, policies, procedures, and system updates to ensure that all eligibility determinations, reviews, and changes are completed accurately with satisfactory documentation. Makes accurate determinations of eligibility based on the rules and standards detailed by the Department and defined in written performance standards. Resolves discrepancies in case determinations or documentation a timely manner. Follows appropriate escalation processes as outlined in eligibility process documentation. Labels all documentation, records decision and notes clearly and accurately in the appropriate systems of record. Provides technical assistance and/or training to staff, management, public and outside agencies, such as DDSN, DHEC, and Family Services and Family Connections.
- Maintains a professional demeanor and communication style, ensuring that communication and interactions with coworkers, supervisors, and beneficiaries is clear, polite, and concise. Participates in customer service and privacy training and ensures that confidential or private information is maintained in accordance with State and Federal laws articulated through departmental policies and training. There should be no more than 2 valid customer service complaints monthly.
- Attends all mandatory meetings, trainings, and events as directed by supervisory staff and agency leadership. Maintains awareness of and complies with all agency policies, to include privacy, confidentiality, standards of conduct, performance, leave and compensation, vehicle use and travel, and financial controls. Maintains appropriate certification and training to perform emergency management evacuation and shelter duties as necessary. Performs other duties as assigned by supervisory staff and agency leadership.
- 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.
- 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.
- Considerable knowledge of Medicaid eligibility policies and procedures and the Medicaid Determination Eligibility System (MEDS) or Curam.
- Effective communication and organizational skills.
- Knowledge of Windows, Microsoft Word and Excel.
- Should exemplify professionalism at all times and contribute to good teamwork practices and overall success of the Division.
- Should be able to identify a need, make decisions, and respond appropriately.
- Ability to maintain confidentiality.
- Yes
- No
- Yes
- No
- Yes
- No
- Yes
- No
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Eligibility Coordinator I - Columbia, United States - State of South Carolina
Description
Salary: $37, $70,054.00 AnnuallyLocation : Richland County, SC
Job Type: FTE - Full-Time
Job Number:
Agency: Department of Health and Human Services
Division: Eligibility, Enrollment, and Member Services (EEMS)
Opening Date: 05/01/2024
Closing Date: 5/7/2024 11:59 PM Eastern
Class Code:: GA45
Position Number::
Normal Work Schedule:: Monday - Friday (8:30 - 5:00)
Pay Band: Band 5
Opening Date: 03/14/2024
EEO Statement: Equal Opportunity Employer
Agency Specific Application Procedures:: Failure to provide detailed and complete information may result in your application not being referred.
Veteran Preference Statement: South Carolina is making our Veterans a priority for employment in state agencies and institutions.
Job Responsibilities
*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.
This position is located in Specialty Unit A, Richland County.
Are you the One? We are looking for an Eligibility Coordinator I who will determine/re-determine Medicaid eligibility assigned to the Specialty Unit included but not limited to TEFRA, Breast Cervical Cancer Program (BCCP), Tuberculosis, and the Palmetto Coordinated System of Care (PCSC) Waiver. Demonstrates positive, cooperative and professional relationships and customer service with staff, co-workers, customers, providers, administrators, the general public, and all stakeholders. Must exhibit dependability/reliability/time management by reporting to work on time, by meeting work schedules & deadlines and completing job tasks effectively and efficiently.
A high school diploma and relevant program experience.
A bachelor's degree may be substituted for the required program experience.
Preferred: Two (2) years of experience with Medicaid Eligibility policy and procedures, and the Medicaid Determination Eligibility System (MEDS) or Curam.
Additional Requirements:
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.
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.
01
The responses you provide to these Supplemental Questions will be used in combination with your application to determine whether you meet the minimum qualification requirements. Please, thoroughly complete the Education and Work Experience sections of your application and the Supplemental Questions. Failure to provide detailed and complete information will result in your application being rejected. Any misrepresentation or omissions will result in your disqualification from employment and/or termination. You may not submit resumes in lieu of filling out the application or answering the Supplemental Questions. I acknowledge that I have read, understand, and agree with the above.
Do you have a high school diplma/GED or higher?
Do you have relevant experience in customer services, social services, human services, and/or Medicaid processing?
Do you wish to claim Veteran Preference? If yes, you must submit a copy of your DD214 Form with your job application in order to qualify and claim this preference?
How did you hear about this career opportunity?
Required Question
