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NEOGOV · 14 hours ago

INTERNAL Eligibility Specialist II Team Lead (MAGI) / TG61100158

Spartanburg County, SC

Full-time, Contract

Onsite

Mid Level

$34K/yr - $41K/yr

NEOGOV is part of the South Carolina Department of Health and Human Services, seeking an Eligibility Specialist II Team Lead (MAGI). This role is responsible for determining eligibility for the Medicaid program by evaluating documentation and ensuring the integrity of the program.

GovTechHuman ResourcesInformation TechnologySoftware

No H1B

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

In addition to meeting minimum standards for timely determinations in accordance with the Department’s EPSM, serves as a subject matter expert and first tier escalation authority for individuals on their team

Provides weekly individualized guidance for up to 4 team members and provides recommendations for the relevant team supervisor for performance evaluations and periodic counseling

Assists new and underperforming team members with developing work improvement strategies

Proficient with 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 as to individual eligibility based on the rules and standards detailed by the department as defined in written performance standards for the relevant type of determination needed

Resolves discrepancies in a timely manner

Follows appropriate escalation processes as outlined in eligibility process documentation

Labels all documentation, records decision and notes clearly and accurately, and 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 processingEligibility determinationCustomer serviceMicrosoft OfficeMathematical computationsCommunication skillsTeam leadership

Required

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

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

Demonstrates high performance standards