INTERNAL POSTING: EEMS QUALITY REVIEW SPECIALIST (MAGI) (Program Coordinator I) / 60015543

Full Job Description

Are you the One? We are looking for an EEMS QUALITY REVIEW SPECIALIST (MAGI) who will evaluate the accuracy of eligibility determinations made by Eligibility Specialists. Quality Specialists complete quality reviews of eligibility determinations in an accurate and timely manner.

• In accordance with the timeliness standards set by the department, completes quality reviews of eligibility determinations. These determinations include, but are not limited to, applications, reviews and changes of circumstances.
• Ensures that all quality reviews of eligibility determinations are completed accurately using the appropriate error codes. Thoroughly and accurately documents results of quality reviews according to quality assurance team guidelines. Follows appropriate escalation processes for procedural errors.

Maintains a professional demeanor and communication style, ensuring that communication and interactions with internal and external stakeholders 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 law as articulated through departmental policies and training.

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.

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.




Requirements

A high school diploma and relevant professional experience in social service programs, business administration, general administrative management.

One (1) year of processing Medicaid applications preferred. Must have exceptional attention to detail

Additional Requirements:
• 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

Qualifications

Knowledge of Medicaid laws, regulations, policies and procedures. Ability to interpret and apply laws, regulations, policies and procedures.

Ability to learn, retain, and apply information about federal rules and standards for reviewing Medicaid eligibility determinations. Ability to exercise judgment and discretion.

Ability to establish and maintain effective working relationships. Ability to communicate effectively in writing and orally.

Familiarity with computers, standard Microsoft Office software and internet browsers. Ability to perform basic mathematical computations.

Ability to work in a professional office environment with a diverse group of teammates.

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.