Eligibility Specialist II Team Lead (MAGI) / 60013065

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 of the Midlands, Richland County. This is an in-office role and not a telecommute or remote position.

About the role

We are looking for an Eligibility Specialist II Team Lead (MAGI) 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, this role serves as a subject matter expert and first tier escalation authority for individuals on their team.

Responsibilities

• 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.
• Follow policies and procedures for the collection and analysis of applications and documentation; collect additional information for beneficiaries as necessary with the least burden to the applicant/beneficiary as possible.
• Perform follow-up activities in an efficient and effective manner, using the communication method most appropriate for obtaining outstanding information in a timely manner.
• Document all notes and steps clearly and completely for review and hand-off to other specialists.
• Provide weekly individualized guidance for up to 4 team members and provide recommendations for the relevant team supervisor for performance evaluations and periodic counseling.
• Assist new and underperforming team members with developing work improvement strategies.
• Ensure proficiency with all processes, policies, procedures, and system updates to complete eligibility determinations, reviews, and changes accurately with satisfactory documentation.
• Make 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.
• Resolve discrepancies in a timely manner and follow appropriate escalation processes as outlined in eligibility process documentation.
• Label all documentation, record decisions and notes clearly and accurately in the appropriate systems of record.
• Maintain a professional demeanor and communication style, ensuring interactions with co-workers, supervisors, and beneficiaries are clear, polite, and concise.
• Participate in customer service and privacy training and ensure confidential or private information is maintained in accordance with State and Federal law as articulated through departmental policies and training.
• 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, standards of conduct, performance, leave and compensation, vehicle use and travel, and financial controls.
• Maintain appropriate certification and training to perform emergency management evacuation and shelter duties as necessary.
• Perform other duties as assigned by supervisory staff and agency leadership.

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.
• Ability to sit or stand 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.
• Ability to perform basic mathematical computations.
• Ability 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.
• Ability to learn, retain, and apply information about federal rules and standards for processing Medicaid eligibility determinations.
• Maintain productive workspaces and perform tasks effectively to ensure the completeness, accuracy, and timeliness of eligibility determinations.
• Demonstrates high performance standards.

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.

Pay

$40,937