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Company | State of South Carolina |
Address | Columbia, SC, United States |
Employment type | FULL_TIME |
Salary | |
Category | Government Administration |
Expires | 2023-07-01 |
Posted at | 11 months ago |
Job Responsibilities
- When applicable, gathers and/or analyzes additional information provided by the petitioner, Eligibility Policy Team and/or Eligibility Quality Team to determine relevancy to the proposed action and complete an eligibility decision utilizing this information. Prepares and sends the Appeals Packet to the Division of Appeals and Hearings and to the petitioner per policy. Responds to any interlocutory, prehearing orders or Orders to Produce received from the Division of Appeals and Hearings within the required timeframes.
- Stays abreast of all current SCDHHS policy and procedures pertaining to Medicaid eligibility and the appeals process.
- Complete other job duties as assigned. May require performing tasks across the team or other business units within the agency.
- Follows the directives in the Final Administrative Decision and/or Order of Remand when issued by the Division of Appeals and Hearings. When ordered, make a new eligibility determination and issue a new Notice of Action to the applicant/beneficiary. Follows Medicaid policies and timeliness procedures to respond to the applicant/beneficiary/petitioner if an appeal is filed based on a new decision. Takes necessary actions to determine/reinstate eligibility when the previous decision was reversed.
- Analyzes case information to determine the accuracy of the eligibility decision. Reviews case findings and ensures the receipt of a request for Fair Hearing. Reviews case file for documentation of legal representation if petitioner is someone other than the applicant/beneficiary. Provides information regarding case decisions and guidance for corrective action to eligibility workers and eligibility supervisors when eligibility determinations are inaccurate. Identifies error trends and reports findings to direct supervisor.
- Attends hearings to represent the Department of Health and Human Services and present evidence to support the eligibility decision.
- Health, Dental, Vision, Long Term Disability, and Life Insurance for Employee, Spouse, and Children.
- 13 paid holidays.
- State Retirement Plan and Deferred Compensation Programs.
- 15 days sick leave per year.
- 15 days annual (vacation) leave per year.
- Sitting or standing for long periods of time.
- Overtime and/or weekend work with Deputy approval.
- Lifting requirements: 20 lbs.
- Knowledge of appeal and hearings or court experience.
- Must have strong oral and written communication skills and be able to communicate effectively.
- Ability to interpret and apply laws, regulations, policies and procedures.
- Candidate must establish and maintain professional interaction with agency staff, service provider staff and Medicaid applicants/beneficiaries/petitioners.
- Ability to exercise judgment and discretion.
- Knowledge of MAGI Medicaid eligibility.
- Knowledge of SCDHHS Medicaid Eligibility Policies and Procedures as well as general knowledge of applicable state and federal regulations.
- Knowledge of SCDHHS Medicaid Eligibility systems such as MEDS, CURAM, Mobius, OnBase, MMIS, CGIS is preferred.
- Must be able to gather information in a timely and accurate manner and demonstrate attention to detail.
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