Program Coordinator I / 60013965

State of South Carolina•Columbia, SC

31d

About The Position

The Agency's mission is to be boldly innovative in improving the health and quality of life for South Carolinians. This is position is located in Eligibility Determinations & Appeals, Richland County. Are you the One? We are looking for a Program Coordinator I who will promote the mission and values of SCDHHS. Under limited supervision, serves as Non-MAGI Eligibility Respondent Coordinator and is cross trained to process MAGI and Specialty appeal requests. Will represent the agency in both formal and informal hearings and appeals processes. Reviews case records to ensure the Medicaid decision under appeal was accurately determined based upon the correct application of Medicaid policies and procedures. Ensures an accurate and timely response to applicant/petitioner requests for Fair Hearing. Analyzes case information to determine the accuracy of the eligibility decision. Reviews case findings and ensures the receipt of a request for Fair Hearing. Reviews case file for documentation of legal representation if petitioner is someone other than the applicant/beneficiary. Provides information regarding case decisions and guidance for corrective action to eligibility workers and eligibility supervisors when eligibility determinations are inaccurate. Identifies error trends and reports findings to direct supervisor. When applicable, gathers and/or analyzes additional information provided by the petitioner, Eligibility Policy Team and/or Eligibility Quality Team to determine relevancy to the proposed action and complete an eligibility decision utilizing this information. Prepares and sends the Appeals Packet to the Division of Appeals and Hearings and to the petitioner per policy. Responds to any interlocutory, prehearing orders or Orders to Produce received from the Division of Appeals and Hearings within the required timeframes. Attends hearings to represent the Department of Health and Human Services and present evidence to support the eligibility decision. Follows the directives in the Final Administrative Decision and/or Order of Remand when issued by the Division of Appeals and Hearings. When ordered, make a new eligibility determination and issue a new Notice of Action to the applicant/beneficiary. Follows Medicaid policies and timeliness procedures to respond to the applicant/beneficiary/petitioner if an appeal is filed based on a new decision. Takes necessary actions to determine/reinstate eligibility when the previous decision was reversed. Stays abreast of all current SCDHHS policy and procedures pertaining to Medicaid eligibility and the appeals process. Complete other job duties as assigned. May require performing tasks across the team or other business units within the agency. 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 program experience.
Occasional overnight travel.
Overtime and/or weekend work with Deputy approval.
Sitting or standing for long periods of time.
Lifting requirements: 20 lbs.
Valid driver's license.
Requires holder to drive routinely.

Nice To Haves

Knowledge of Medicaid (Non-MAGI) eligibility, appeal and hearings or court experience and strong oral and written communication skills.
Ability to exercise judgment and discretion.
Must have strong oral and written communication skills and be able to communicate effectively.
Candidate must establish and maintain professional interaction with agency staff, service provider staff and Medicaid applicants/beneficiaries/petitioners.
Must be able to gather information in a timely and accurate manner and demonstrate attention to detail.
Ability to interpret and apply laws, regulations, policies and procedures.
Knowledge of SCDHHS Medicaid Eligibility systems such as MEDS, CURAM, Mobius, OnBase, MMIS, CGIS is preferred.
Statewide travel to hearings is required.

Responsibilities

Serves as Non-MAGI Eligibility Respondent Coordinator and is cross trained to process MAGI and Specialty appeal requests.
Represents the agency in both formal and informal hearings and appeals processes.
Reviews case records to ensure the Medicaid decision under appeal was accurately determined based upon the correct application of Medicaid policies and procedures.
Ensures an accurate and timely response to applicant/petitioner requests for Fair Hearing.
Analyzes case information to determine the accuracy of the eligibility decision.
Reviews case findings and ensures the receipt of a request for Fair Hearing.
Reviews case file for documentation of legal representation if petitioner is someone other than the applicant/beneficiary.
Provides information regarding case decisions and guidance for corrective action to eligibility workers and eligibility supervisors when eligibility determinations are inaccurate.
Identifies error trends and reports findings to direct supervisor.
When applicable, gathers and/or analyzes additional information provided by the petitioner, Eligibility Policy Team and/or Eligibility Quality Team to determine relevancy to the proposed action and complete an eligibility decision utilizing this information.
Prepares and sends the Appeals Packet to the Division of Appeals and Hearings and to the petitioner per policy.
Responds to any interlocutory, prehearing orders or Orders to Produce received from the Division of Appeals and Hearings within the required timeframes.
Attends hearings to represent the Department of Health and Human Services and present evidence to support the eligibility decision.
Follows the directives in the Final Administrative Decision and/or Order of Remand when issued by the Division of Appeals and Hearings.
When ordered, make a new eligibility determination and issue a new Notice of Action to the applicant/beneficiary.
Follows Medicaid policies and timeliness procedures to respond to the applicant/beneficiary/petitioner if an appeal is filed based on a new decision.
Takes necessary actions to determine/reinstate eligibility when the previous decision was reversed.
Stays abreast of all current SCDHHS policy and procedures pertaining to Medicaid eligibility and the appeals process.
Complete other job duties as assigned.
May require performing tasks across the team or other business units within the agency.

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.

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