INTERNAL Eligibility Coordinator I (Non-MAGI) (Escalations Coordinator I) / TG61100326RP

Full Job Description

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

***Internal Posting- Only current SCDHHS Employees will be considered.***

Are you the One? We are looking for an Eligibility Coordinator I (Non-MAGI) (Escalations Coordinator I) who, under supervision of the Eligibility Coordinator II for Eligibility, Enrollment, and Member Services (EEMS), the Escalation Coordinator I serves as Tier 2 Escalation Eligibility Coordinator and is responsible for assisting in the training of the Escalation Team. Provides support to the leadership and the Non-Magi (NM) Escalation team. Responsible for timely and accurate eligibility determinations and positive customer service. The Eligibility Coordinator determines/re-determines Medicaid eligibility according to Center for Medicare and Medicaid Services regulations and guidelines and policies and procedures.

Supports the supervisors of the Escalation Team and the Escalation Specialists. Providing direct onsite and team training to the team. Implements agency-standard workflow processes and procedures.

Provides guidance to team members and agency managers on the effectiveness of agency policies, procedures, and processes.

Performs accurate and timely eligibility determinations for NM cases. Upon review and analysis of all available data, worker will request needed verifications, or complete the budget, make the determination, and update all systems as appropriate while maintaining accurate and precise documentation.

Provides technical assistance to Medicaid Eligibility Specialists and aids in the resolution of common questions, concerns, and escalations received by Medicaid Eligibility Specialists.

Accurately addresses or routes questions and escalations to the appropriate resource including team leads, training staff, or help desk professionals, among others.

Periodically spot-checks worker performance with respect to attendance, productivity, completeness of application workbooks, and accuracy of determinations.

Conducts a thorough assessment of the entire application upon receiving. Identifies all documents needed based on applicant's information and background.

Conducts collateral calls and develops a comprehensive checklist for all verifications needed along with specific details and explanations if needed.

Completes disability packets and income trust packets as necessary.

Completes income verifications, bank and life insurance release forms, burial exclusion forms, level of care forms, intent to return home, and other related documents as needed.

Research interfaces, public records, and third-party sources. Worker will assist client in obtaining needed verification if necessary.

Attends meetings and training sessions as required. Makes and keeps schedules, completes tasks timely and reports to work timely.

Assists eligibility management and senior leadership with projects as assigned. Performs related duties as assigned or required.

Performs and coordinates preparedness/shelter duty activities as assigned.

• 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.

Requirements

A high school diploma and relevant program experience.

A bachelor’s degree may be substituted for the required program experience.

Preferred: At least two (2) years of working in Medicaid Non-MAGI related programs.

Additional Requirements:

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

Qualifications

• Extensive knowledge of the Medicaid Program, human services programs, or eligibility processing preferred.
• Supervisory and management experience preferred.
• Higher skillset to analyze and interpret broad health and human escalated service case and provider issues and their impact on the Department's programs.
• Extensive knowledge of laws, regulations, policies and procedures relevant to the area of employment.
• Ability to exercise judgment and discretion.
• Ability to establish and maintain effective working relationships with internal and external stakeholders.
• Ability to effectively manage time and prioritize escalated tasks and departmental and agency projects with competing and/or shifting deadlines.
• Ability to communicate and collaborate with team members and external stakeholders from different levels of hierarchy.
• Requires Emergency Preparedness Shelter Duties.

Additional Information

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.