Eligibility Specialist II; MAGI

Eligibility Specialist II (MAGI)

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 Specialty Unit B, Richland County. This is an in-office role and not a telecommute or remote position. Are you the One? We are looking for an Eligibility Specialist II (MAGI) who will determine/re-determine Medicaid eligibility according to Medicaid policies and procedures.

This position collects and evaluates documentation from applicants to determine individual and family eligibility for Medicaid programs. Eligibility Specialists complete all assigned eligibility determinations, reviews, and changes in an accurate and timely manner. Demonstrates positive, cooperative and professional relationships and customer service with staff, co-workers, customers, providers, administrators, the general public, and all stakeholders. Must exhibit dependability/reliability/time management by reporting to work on time, by meeting work schedules & deadlines and completing job tasks effectively and efficiently.

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.

This includes but not limited to communication with DSS for Foster Care applications, World Relief and/or Lutheran Services for Refugee applications, and DJJ for applications placed by their agency. Performs follow-up activities in an efficient and effective manner, using the most appropriate communication method for obtaining outstanding information in a timely manner. Documents all notes and steps clearly and completely for review and hand-off to other specialists.

In addition to meeting minimum standards for timely determinations in accordance with the Department's EPSM and serving as a liaison to other government agencies specialist is responsible for maintaining time limited specialized cases expedited to the unit.

Demonstrates 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. Makes accurate determinations of eligibility based on the rules and standards detailed by the Department and defined in written performance standards. Resolves discrepancies in case determinations or documentation in a timely manner. Follows appropriate escalation processes as outlined in eligibility process documentation.

Labels all documentation, records decision and notes clearly and accurately in the appropriate systems of record.

Provides technical assistance and/or training to staff, management, public and outside agencies, such as DSS, DJJ and Family Services and Family Connections.

Maintains a professional demeanor and communication style, ensuring that communication and interactions with coworkers, 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. There should be no more than 2 valid customer service complaints monthly.

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.

The South Carolina Department of Health and Human Services offers an exceptional benefits package for FTE and TGE positions that includes:
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.

Minimum and

Additional Requirements:

A high school diploma and relevant program 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. Occasional overnight travel. Sitting or standing for long periods of time. Lifting requirements: 20 lbs. In-office Role.

Preferred Qualifications:

Eligibility…