Job description
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, Determinations & Appeals , Richland County.
Are you the One? We are looking for a Program Coordinator I who serves as LTC Eligibility Respondent Coordinator and is cross trained in Non-Magi cases. 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 the 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.
- When applicable, 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.
- Attends hearings to represent the Department of Health and Human Services and present evidence to support the eligibility decision.
- 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.
- Stays abreast of all current SCDHHS policy and procedures pertaining to Medicaid eligibility and the appeals process.
- Complete other job duties as assigned. May require performing tasks across the team or other business units within the agency.
- 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.
Bachelor's degree may be substituted for the required program experience.
Preferred: Knowledge of Medicaid (MAGI) eligibility and the SCDHHS appeal process.
Additional Requirements:
- Sitting or standing for long periods of time.
- Overtime and/or weekend work with Deputy approval.
- Lifting requirements: 20 lbs.
- Occasional overnight travel.
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.
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