ELIGIBILITY SPECIALIST II (MAGI)

$31,561 - $35,776/Yr

State of South Carolina - Spartanburg, SC

Full-time - Entry Level

Remote - Spartanburg, SC

Executive, Legislative, and Other General Government Support

About the position

The South Carolina Department of Health and Human Services is seeking an Eligibility Specialist II (MAGI) to join the Localized Eligibility Processing (LEP) team in Spartanburg County. This full-time position is crucial in determining and re-determining Medicaid eligibility in accordance with established policies and procedures. The selected candidate will be responsible for collecting and evaluating documentation from applicants to assess individual and family eligibility for Medicaid programs. This role requires a high level of accuracy and timeliness in completing all assigned eligibility determinations, reviews, and changes. The Eligibility Specialist will utilize various information sources, electronic tools, and systems provided by the Department to gather, assemble, evaluate, and act upon information provided by applicants, beneficiaries, and third parties. It is essential to follow policies and procedures for the collection and analysis of applications and documentation, ensuring that the burden on applicants is minimized. The specialist will also perform follow-up activities efficiently, using appropriate communication methods to obtain outstanding information in a timely manner. Documentation is a key aspect of this role; the specialist must clearly and completely document all notes and steps taken for review and hand-off to other specialists. Proficiency in utilizing all processes, policies, procedures, and system updates is necessary to ensure that all eligibility determinations, reviews, and changes are completed accurately with satisfactory documentation. The specialist will resolve discrepancies in case determinations or documentation promptly and follow appropriate escalation processes as outlined in eligibility process documentation. Maintaining a professional demeanor and communication style is vital, ensuring that interactions with co-workers, supervisors, and beneficiaries are clear, polite, and concise. Additionally, the specialist will participate in customer service and privacy training, ensuring that confidential or private information is maintained in accordance with State and Federal law. Attendance at all mandatory meetings, trainings, and events as directed by supervisory staff and agency leadership is required. The role may also involve performing emergency management evacuation and shelter duties as necessary, along with other duties assigned by supervisory staff and agency leadership.

Responsibilities

• Determine and re-determine Medicaid eligibility according to Medicaid policies and procedures.
• Collect and evaluate documentation from applicants to determine individual and family eligibility for the program.
• Complete all assigned eligibility determinations, reviews, and changes in an accurate and timely manner.
• Utilize various information sources, electronic tools, and systems to collect, assemble, evaluate, and act upon information provided by applicants and third parties.
• Follow policies and procedures for the collection and analysis of applications and documentation.
• Perform follow-up activities efficiently to obtain outstanding information in a timely manner.
• Document all notes and steps clearly and completely for review and hand-off to other specialists.
• Demonstrate proficiency in utilizing all processes, policies, procedures, and system updates to ensure accurate eligibility determinations.
• Resolve discrepancies in case determinations or documentation in a timely manner.
• Maintain a professional demeanor and communication style with co-workers, supervisors, and beneficiaries.

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.
• Familiarity with computers and standard Microsoft Office software.
• Ability to read, write, and speak English clearly and concisely.
• Basic mathematical computation skills.
• Ability to work in a professional office environment with a diverse group of teammates.

Nice-to-haves

• Experience in Medicaid processing or related fields.
• Ability to learn, retain, and apply information about federal rules and standards for processing Medicaid eligibility determinations.
• Experience providing excellent customer service face to face, telephonically, or through written communication.

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.