Eligibility Specialist II (LTCW) / TG61096544

State of South Carolina • Columbia, SC

45d

About The Position

This is a Temporary Grant Position.

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 Eligibility, Enrollment and Member Service (EEMS) Processing Centers, Richland County.

Are you the One? We are looking for an Eligibility Specialist II (LTCW) who is the front-line of beneficiary access to the Medicaid program. This position collects and evaluates documentation from applicants to determine individual and family eligibility for the program. Eligibility Specialists ensure the integrity of the Medicaid program by completing all eligibility determinations, reviews, and eligibility changes in an accurate and timely manner. In addition to meeting minimum standards for timely determinations in accordance with the Department's EPSM, serves as a subject matter expert and first tier escalation authority for individuals on their team.

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. 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.
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.
Maintains a professional demeanor and communication style, ensuring that communication and interactions with co-workers, 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 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 experience in customer services, social services, human services, and/or Medicaid processing.
• A bachelor's degree may be substituted for the required program experience.
• Overtime and/or weekend work with Deputy approval.
• Sitting or standing for long periods of time.
• Lifting requirements: 20 lbs.

Nice To Haves

• Eligibility Specialists must have a familiarity with computers, standard Microsoft Office software, internet browsers, and the ability to read, write, and speak English in a clear and concise manner.
• Must be able to perform basic mathematical computations.
• Eligibility Specialists must be able to work in a professional office environment with a diverse group of teammates and provide excellent customer service either face to face, telephonically or through written communication.
• Eligibility Specialists must be able to learn, retain, and apply information about federal rules and standards for processing Medicaid eligibility determinations.
• Specialists must maintain productive workspaces and must perform tasks in an effective manner to ensure the completeness, accuracy, and timeliness of eligibility determinations.
• Demonstrates high performance standards.

Responsibilities

• 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.
• 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.
• 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.
• Maintains a professional demeanor and communication style, ensuring that communication and interactions with co-workers, 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 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.

Benefits

• 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.

What This Job Offers

• Job Type: Full-time
• Career Level: Entry Level
• Industry: Executive, Legislative, and Other General Government Support
• Education Level: High school or GED