Post Payment Claims Review Coordinator

Job Responsibilities

About Our Agency

The South Carolina Department of Disabilities and Special Needs (DDSN) is the state agency that plans, develops, coordinates, and funds services for South Carolinians with the severe, lifelong disabilities of:

• Spinal cord injury and similar disability
• Traumatic brain injury
• Intellectual disability and related disabilities
• Autism spectrum disorder

This posting seeks to fill three (3) vacancies.

Responsible for conducting Post Payment Claims reviews of providers within the DDSN provider network. Reviews claims data to make determinations regarding payment within the Post Payment Claims Review Process. Ensures timely completion of each step within the review process and communication with the provider.

Responsible for reviews as team lead and subject matter expert for a specific service area. As the subject matter expert, assist with the interpretation of standards and directives in the identified area. Assist the supervisor in ensuring that providers in the subject matter area are reviewed according to DDSN standards.

Ability to use systems identified by DDSN to research claims, gather information regarding services, and to document findings.

Participates in special projects and/or special circumstance reviews (ad hoc) as needed.

Minimum And Additional Requirements

A high school diploma and two (2) years of relevant program experience.

Additional Comments

EEO Statement: SC DDSN provides affirmative action and equal opportunity in employment for all qualified persons regardless of race, color, sex --including the basis of pregnancy, childbirth, or related medical conditions, national origin, age, religion, or disability.

Record Check: Criminal background check will be conducted by SLED, FBI, and DSS Child Registry that indicates no record of conviction, child abuse or neglect. Employment would also be contingent on your passing a pre-employment drug test. DDSN reserves the right to rescind any employment offer in the event our review of your background develops information, including opinions of previous employer or colleagues that cause us to conclude, at our sole discretion, that you are not suited for the position.

Immunization: If this position requires the applicant to work directly with DDSN consumers, a (2) step PPD testing or QuantiFERON TB Gold testing must be completed prior to beginning employment. All new employees who are healthcare providers are required to provide documentation of immunity or be immunized against measles, mumps, rubella, pertussis, Varicella and Hepatitis B prior to beginning employment.

State Disaster Plan: In accordance with the State's Disaster Plan, which includes hazardous weather, DDSN employees may be required to work in times of an emergency or disaster.

College Transcripts: Applicants indicating college credit or degree(s) on the application are required to provide an official, certified copy of the transcript prior to hiring or within a specific time frame required by that area, after hiring.

Driving Record: If this position requires the applicant to possess a valid driver's license to operate a state vehicle or personal vehicle, any applicant being considered in the final stages of selection for the position will be required to provide a certified copy of a 10-year driving record.

Employee Referral: The South Carolina Department of Disabilities and Special Needs supports a Referral Incentive Reward and a Retention Bonus program. You may contact Human Resource for further information .

Supplemental Questions: Supplemental questions are considered part of your official application. Any misrepresentation will result in your disqualification from employment. 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.