Policy, Procedure, & Contracts Coordinator (Program Coordinator II) - 61008819

Full Job Description

Careers at DPH: Work that makes a difference!

Pursuing Excellence, Inspiring Innovation, Promoting Teamwork, Embracing Service, and Advancing Equity

Job duties will include, but are not limited to:

• Billing Policy Leadership

  • Maintain expert-level knowledge of program and payer policies, rules, and regulations related to billing and reimbursement.

  • Provide interpretation, direction, and guidance to program areas and clinic facilities statewide.
  • Develop new policies and revise existing ones as needed to maintain compliance.
  • Communicate and distribute updates through email, trainings, and meetings.
    
    

• Payer Enrollment, Credentialing & Revalidation

  • Complete statewide Medicare, Medicaid, and commercial payer enrollment, credentialing, and revalidation applications for clinic locations and providers.
  • Ensure all payers remain updated or enrolled with the clearinghouse for accurate and timely claim processing.
    
    

• Medicaid & Commercial Contract Management

  • Assist with administration and performance oversight of statewide Medicaid and commercial insurance contracts.
  • Draft, revise, and prepare contract documents, ensuring accuracy and completeness for submission.
  • Collaborate with internal and external partners, including legal teams, to negotiate contract terms and conditions.
  • Monitor contract compliance, performance metrics, and deliverables to ensure obligations are met.
    
    

• Revenue Cycle Monitoring & Issue Resolution

  • Track revenue performance in Rev Cycle and Rev Manager systems.
  • Review claim queues to identify issues, reduce processing errors, and support timely payment.
  • Analyze denials and rejections to support problem-solving and accelerate reimbursement.
  • Monitor and assist with secondary claim processing following primary adjudication.
  • Report system or processing issues promptly to ensure timely corrective action.
    
    

• Financial Audit & Compliance Oversight

  • Monitor all financial audits to ensure alignment with policies, procedures, and payer requirements.
  • Review payer-driven audits and records requests to ensure timely and accurate response.
  • Initiate claim corrections based on audit findings and document updates in the EHR.
  • Summarize audit results and communicate relevant findings to appropriate departments.
    
    

• Other Duties as Assigned

  • Provide training and technical assistance to billing teams across the state.
  • Assist with troubleshooting, workflow optimization, and billing system updates.
  • Participate in presentations, workshops, and training sessions.
  • Support updates to the Patient Billing Policy Manual.
  • Perform other related duties as assigned.

Requirements

State Minimum:
A bachelor's degree and relevant program experience.

Institutions of Higher Learning must be recognized by the Council for Higher Education Accreditation.

Agency Minimum:
A bachelor's degree and four (4) years, associate's degree and six (6) years, or high school diploma and eight (8) years administrative or professional experience. Ability to work under conditions of constant change, perform acceptably under stress and be able to communicate orally and in writing at all levels of the agency. Position requires significant amount of intrastate travel.

**Any equivalent combination of education and/or experience that demonstrates the required knowledge, skills, and abilities may be considered in meeting the minimum qualifications, subject to approval by the DPH Chief Human Resources Officer, or their delegate.**

Applicants indicating college credit or degree(s) on the application may upload an unofficial copy of the transcript as an attachment to the application. Please note that the agency will require an official, certified copy of the transcript or diploma prior to hiring.

Qualifications

Medical billing, contract management and/or managed care experience. Electronic Health Record experience. Thorough knowledge of billing Medicare, Medicaid and other third party payers for health services. Revenue management experience within an Electronic Health Record system. Ability to adjust to changing program needs for consultation/support/direction in relation to billing/revenue enhancement for program activities. Knowledge of government accounting systems.

Additional Information

EEO: The Department of Public Health 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.

REASONABLE ACCOMMODATION: Applicants needing accommodation for medical reasons or a sincerely held religious belief may submit a request for accommodation. A reasonable accommodation may be granted if it doesn't impose an undue hardship or pose a direct threat to the health and safety of others.

STATE DISASTER PLAN: In accordance with the State's Disaster Plan, which includes hazardous weather, Department of Public Health employees may be required to work in times of an emergency or disaster.

DRIVING RECORD: If this position requires the applicant to possess a valid driver's license to operate a state vehicle or personal vehicle, any applicant being considered in the final stages of selection for the position will be required to provide a certified copy of a 10-year driving record.

The South Carolina Department of Public Health offers an exceptional benefits package for FTE positions that includes:

• 15 days Annual (Vacation) Leave per year
• 15 days Sick Leave per year
• 13 Paid Holidays
• Paid Parental Leave
• Health, dental, vision, long-term disability, and life insurance for employees, spouse, and children. Click here for additional information.
• S.C. Deferred Compensation Program available (S.C. Deferred Compensation)
• Retirement benefit choices *
  • State Retirement Plan (SCRS)
  • State Optional Retirement Program (State ORP)

*Enrollment in one of the listed plans is required for all FTE employees; please refer to the contribution section of hyperlinked retirement sites for the current contribution rate of gross pay.

HYBRID WORK: The option to work partially remote or adjusted work hours may be available after 12 months of employment for approved positions.