Eligibility Specialist II Team Lead (LTC) / 61100324TG

Job Responsibilities

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. This is an in-office role and not a telecommute or remote position.

• Collects and evaluates documentation from applicants to determine individual and family eligibility for the program.
• Ensures the integrity of the Medicaid program by completing all eligibility determinations, reviews, and eligibility changes in an accurate and timely manner.
• 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.
• Makes accurate determinations as to individual eligibility based on the rules and standards detailed by the department as defined in written performance standards for the relevant type of determination needed.
• Resolves discrepancies in a timely manner.
• Follows appropriate escalation processes as outlined in eligibility process documentation.
• Limits the burden on the applicant/beneficiary as much as possible while collecting all necessary information.
• Provides weekly individualized guidance for up to 4 team members and provides recommendations for the relevant team supervisor for performance evaluations and periodic counseling.
• Aids new and underperforming team members with developing work improvement strategies.
• Proficient with all processes, policies, procedures, and system updates to ensure that all eligibility determinations, reviews, and changes are completed accurately with satisfactory documentation.
• 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.

Qualifications

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.

Additional Requirements

• Overtime and/or weekend work with Deputy approval.
• Sitting or standing for long periods of time.
• Lifting requirements: 20 lbs.
• In-office role.

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.
• The ability to perform basic mathematical computations.
• A familiarity with federal rules and standards for processing Medicaid eligibility determinations.
• The ability to maintain productive workspaces and perform tasks in an effective manner to ensure the completeness, accuracy, and timeliness of eligibility determinations.
• The demonstration of high performance standards.