Eligibility Specialist II (LTCW) / 61088203TG

This is a temporary grant-funded, in-office position located in the Escalations Team, Statewide County. The role is not eligible for telecommuting or remote work.

About the role

The South Carolina Department of Health and Human Services (SCDHHS) is seeking an Eligibility Specialist II (LTCW) to determine and redetermine Medicaid eligibility in accordance with established policies and procedures. The specialist will collect and evaluate documentation from applicants to assess individual and family eligibility for Medicaid programs.

Responsibilities

• Complete all assigned eligibility determinations, reviews, and changes accurately and timely.
• Use electronic tools and systems to collect, assemble, evaluate, and act on information from applicants, beneficiaries, and third parties to make timely eligibility decisions.
• Follow policies and procedures for collecting and analyzing applications and documentation, ensuring minimal burden on applicants.
• Perform follow-up activities efficiently, using the most appropriate communication method to obtain outstanding information.
• Document all notes, steps, and decisions clearly and completely for review and handoff to other specialists.
• Demonstrate proficiency in utilizing processes, policies, and system updates to ensure accurate eligibility determinations with satisfactory documentation.
• Make accurate eligibility determinations based on departmental rules and written performance standards.
• Resolve discrepancies in case determinations or documentation in a timely manner.
• Follow appropriate escalation processes as outlined in eligibility documentation.
• Label all documentation and record decisions accurately in the appropriate systems of record.
• Maintain a professional demeanor and communication style with coworkers, supervisors, and beneficiaries.
• Participate in customer service and privacy training, ensuring confidential information is handled in accordance with state and federal laws.
• Attend all mandatory meetings, trainings, and events as directed by supervisory staff and agency leadership.
• Maintain awareness of and comply with all agency policies, including privacy, confidentiality, conduct, performance, leave, compensation, vehicle use, travel, and financial controls.
• Maintain appropriate certification and training for emergency management evacuation and shelter duties.
• Perform other duties as assigned by supervisory staff and agency leadership.

Requirements

• A high school diploma or GED.
• Relevant program experience in customer services, social services, human services, and/or Medicaid processing. A bachelor’s degree may substitute for the required experience.
• Occasional overnight travel.
• Ability to work overtime and/or weekends with deputy approval.
• Ability to sit or stand for long periods and lift up to 20 lbs.
• Proficiency with computers, standard Microsoft Office software, internet browsers, and basic mathematical computations.
• Ability to read, write, and speak English clearly and concisely.
• Ability to work in a professional office environment with a diverse team and provide excellent customer service via face-to-face, telephonic, or written communication.
• Ability to learn, retain, and apply federal rules and standards for processing Medicaid eligibility determinations.
• Ability to maintain a productive workspace and perform tasks effectively to ensure completeness, accuracy, and timeliness of eligibility determinations.

Benefits

• Health, dental, vision, long-term disability, and life insurance for employees, spouses, and children.
• 15 days of annual (vacation) leave per year.
• 15 days of sick leave per year.
• 13 paid holidays.
• State retirement plan and deferred compensation programs (401(k) and 457 options).

Pay

$39,454 per year.