Program Coordinator I (EEMS Respondent Coordinator (MAGI)) / 60020763

Job Responsibilities

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 Appeals & Quality, Richland County. This is an in-office role and not a telecommute or remote position.

Under limited supervision, serves as a MAGI Eligibility Respondent Coordinator and will be cross-trained to process Specialty appeals. 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 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.
• 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.
• Stays abreast of all current SCDHHS policy and procedures pertaining to Medicaid eligibility and the appeals process.
• Attends hearings to represent the Department of Health and Human Services and present evidence to support the eligibility decision. Statewide travel to hearings is required.
• 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.

Minimum and Additional Requirements

• A high school diploma and relevant program experience.
• PREFERRED: Knowledge of SCDHHS Medicaid Eligibility Policies and Procedures as well as general knowledge of applicable state and federal regulations. Knowledge of Medicaid (MAGI eligibility) and the SCDHHS appeal process is preferred. Knowledge of SCDHHS Medicaid Eligibility systems such as CURAM, OnBase, MMIS, and CGIS are preferred.
• Additional Requirements:
• Valid driver's license.
• Requires holder to drive routinely.
• Occasional overnight travel.
• 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

• Ability to exercise judgment and discretion.
• Must have strong oral and written communication skills and be able to communicate effectively.
• The 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.

Additional Comments

Please complete the State application to include all current and previous work history and education. A resume will not be accepted nor reviewed to determine if an applicant has met the qualifications for the position. Supplemental questions are considered part of your official application for qualification purposes. All applicants must apply online. All correspondence from the Office of Human Resources will be through electronic mail.

The South Carolina Department of Health and Human Services is committed to providing equal employment opportunities to all applicants and does not discriminate on the basis of race, color, religion, sex (including pregnancy, childbirth or related medical conditions, including, but not limited to lactation), national origin, age (40 or older), disability or genetic information.

The state of South Carolina offers eligible employees generous benefits, including health and dental insurance; retirement and savings plan options; and paid vacation and sick leave. Plus, work-life balance programs such as telecommuting and flexible work schedules are available to employees of some state agencies.