Eligibility Specialist II (MAGI) / 60016171RP

Job Responsibilities

This position is a re-post. Previous applicants do not need to re-apply.

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 Localized Eligibility Processing (LEP), in Dorchester County. This is an in-office role and not a telecommute or remote position.

The Eligibility Specialist II (MAGI) determines/re-determines Medicaid eligibility according to Medicaid policies and procedures. They collect and evaluate documentation from applicants to determine individual and family eligibility for the program. Eligibility Specialists complete all assigned eligibility determinations, reviews, and changes in an accurate and timely manner. They use 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. They follow policies and procedures for the collection and analysis of applications and documentation and collect additional information for beneficiaries as necessary with the least burden to the applicant/beneficiary as possible. They perform follow-up activities in an efficient and effective manner, using the communication method most appropriate for obtaining outstanding information in a timely manner. They document all notes and steps clearly and completely for review and hand-off to other specialists.

Eligibility Specialists demonstrate 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. They make accurate determinations of eligibility based on the rules and standards detailed by the Department and defined in written performance standards. They resolve discrepancies in case determinations or documentation a timely manner. They follow appropriate escalation processes as outlined in eligibility process documentation. They label all documentation, records decision and notes clearly and accurately in the appropriate systems of record.

Eligibility Specialists maintain a professional demeanor and communication style, ensuring that communication and interactions with co-workers, supervisors, and beneficiaries is clear, polite, and concise. They participate in customer service and privacy training and ensure that confidential or private information is maintained in accordance with State and Federal law as articulated through departmental policies and training. They attend all mandatory meetings, trainings, and events as directed by supervisory staff and agency leadership. They maintain awareness of and comply with all agency policies, to include privacy, confidentiality, standards of conduct, performance, leave and compensation, vehicle use and travel, and financial controls. They maintain appropriate certification and training to perform emergency management evacuation and shelter duties as necessary.

Qualifications

A high school diploma and relevant experience in customer services, social services, human services, and/or Medicaid processing. A bachelor's degree may be substituted for the required program experience.

Additional Requirements

• Overtime and/or weekend work with Deputy approval.
• Sitting or standing for long periods of time.
• Lifting requirements: 20 lbs.
• Occasional overnight travel.

Preferred Qualifications

• Familiarity with computers, standard Microsoft Office software, internet browsers, and the ability to read, write, and speak English in a clear and concise manner.
• Able to perform basic mathematical computations.
• 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.
• Able to learn, retain, and apply information about federal rules and standards for processing Medicaid eligibility determinations.
• Maintain productive workspaces and perform tasks in an effective manner to ensure the completeness, accuracy, and timeliness of eligibility determinations.

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.