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NEOGOV · 1 day ago

Eligibility Specialist II (LTCW) / 61100376TGRP

Richland County, SC

Full-time

Onsite

New Grad, Entry Level

$34K/yr - $54K/yr

NEOGOV is part of the State of South Carolina's Department of Health and Human Services, and they are seeking an Eligibility Specialist II (LTCW) to determine Medicaid eligibility according to policies and procedures. The role involves collecting and evaluating documentation from applicants to ensure accurate and timely eligibility determinations, while maintaining compliance with state and federal laws.

GovTechHuman ResourcesInformation TechnologySoftware

Responsibilities

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. Performs follow-up activities in an efficient and effective manner, using the communication method most appropriate for obtaining outstanding information in a timely manner. Documents all notes and steps clearly and completely for review and hand-off to other specialists

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 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

Maintains a professional demeanor and communication style, ensuring that communication and interactions with co-workers, 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

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

Qualification

Medicaid processingCustomer serviceMicrosoft OfficeBasic mathematicsDocumentation skillsCommunication skillsTeamworkProblem-solving

Required

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

Occasional overnight travel

Overtime and/or weekend work with Deputy approval

Sitting or standing for long periods of time

Lifting requirements: 20 lbs

Preferred

Eligibility Specialists must have a familiarity with computers, standard Microsoft Office software, internet browsers, and the ability to read, write, and speak English in a clear and concise manner

Must be able to perform basic mathematical computations

Eligibility Specialists must be able 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

Eligibility Specialists must be able to learn, retain, and apply information about federal rules and standards for processing Medicaid eligibility determinations

Specialists must maintain productive workspaces and must perform tasks in an effective manner to ensure the completeness, accuracy, and timeliness of eligibility determinations