This position serves as a MAGI (Modified Adjusted Gross Income) Medicaid Eligibility Worker (EW). Under the direction of the supervisor, this individual performs detailed-oriented reviews of information to accurately determine and re-determine Medicaid Eligibility according to Medicaid policies and procedures, adhering to strict deadlines. This individual completes various forms, financial assessments and verifies the accuracy of information. In addition, this position will gather information by utilizing various sources and tools to include face-to-face client interviews, as well as telephonic consultations. This position will track and log work-related activities in multiple complex software systems and maintain proper documentation. This position must meet performance and quality standards while ensuring compliance with all State, Federal, Departmental, and HIPAA rules and regulations.
- Verifies Medicaid Eligibility information provided by applicants/beneficiaries using various sources, systems, and tools to include computing and assessing financial eligibility based on modified adjusted gross income. Analyzes evidence entered into multiple electronic data systems to understand, reconcile, and successfully process eligibility determinations to completion, accurately, and within all deadlines. Obtains, researches and verifies information and completes changes as needed. Meets all deadlines, productivity standards, completion standards, and quality metric standards.
- Must process Medicaid Eligibility determinations with a high degree of quality and accuracy and ensuring compliance with all rules and regulations while meeting deadlines. Medicaid files must be indexed and documented completely and correctly in all systems.
- Works in a cooperative team environment to provide value to both internal and external customers. Provides excellent customer service to public by answering phone calls, returning phone calls within 24 hours and clearing voice mail daily. Conducts client interviews (as needed) both in person and/or over the telephone to clarify and verify provided information. Assists applicants/beneficiaries, stakeholders, other agency employees and management with the upmost professionalism. Educates applicants/beneficiaries and their families on available resources and support on specific Medicaid policies and programs.
- Performs local emergency preparedness and/or local shelter duties as assigned by supervisor. Maintains up-to-date contact information and provides this information to supervisor.
- Participates in staff and other internal meetings and training sessions as assigned.
- Performs other duties as assigned.
Additional Position Requirements:
- Lifting of 20 lbs.
- Occasional overnight travel.
- Overtime and/or weekend work.
- Sitting or standing for long periods of time.
- Ability to interview Medicaid applicants/beneficiaries in order to process Medicaid determinations.
- Ability to use electronic resources to gather facts regarding Medicaid determinations.
- The ability to read, understand, and follow state and federal laws concerning
- Medicaid policy and procedures.
- Ability to exercise judgment and discretion in applying and interpreting rules, regulations, policies and procedures.
- Ability to navigate multiple computer systems, databases, and use decision making skills.
- Must have basic mathematical skills and computer systems skills.
- Must be open to cultural and demographic diversity and have the ability to establish and maintain effective working relationships.
- Must exhibit dependability and reliability and maintain confidentiality.
- Responsible for adhering to all applicable federal, state, departmental, and Health Insurance Portability and Accountability Act (HIPAA) rules and regulations.
- Must have exceptional organizational and time management skills.
- Must have strong verbal and written communication skills.
- Must have exceptional customer service skills.
- Works with the public; works typically in an office setting. Daily contact with applicants/beneficiaries and families in the community either, in person or via phone.
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. Supplemental questions are considered part of your official application for qualification purposes.All applicants must apply on line. All correspondence from the Office of Human Resources will be through electronic mail.
The South Carolina Department of Health and Human Services is committed to providing equal employment opportunities to all applicants and does not discriminate on the basis of race, color, religion, sex (including pregnancy, childbirth or related medical conditions, including, but not limited, to lactation), national origin, age (40 or older), disability or genetic information.
The state of South Carolina offers eligible employees generous benefits, including health and dental insurance; retirement and savings plan options; and paid vacation and sick leave. Plus, work-life balance programs such as telecommuting and flexible work schedules are available to employees of some state agencies.
Eligible employees may enroll in health insurance, which includes prescription coverage and wellness benefits. Other available insurance benefits include dental, vision, term life insurance, long term disability and flexible spending accounts for health and child care expenses.
State employees are also offered retirement plan options, including defined benefit and defined contribution plans. Additionally, eligible employees may elect to participate in the South Carolina Deferred Compensation Program, which is a voluntary, supplemental retirement savings plan offering 401(k) and 457 plan options.
State employees may also be eligible for other benefits, including tuition assistance; holiday, annual and sick leave; and discounts on purchases, travel and more.
Note: The benefits above are available to most state employees, with the exception of those in temporary positions. Employees in temporary grant and time-limited positions may be eligible for all, some or none of these benefits as benefits are associated with each position type. For these positions, contact the hiring agency to determine what benefits may be available.
- Doctorate Degree
- Master's Degree
- Bachelor's Degree
- Associate's Degree
- Some College
- High School Diploma
- Some High School
- No experience
- Less than 1 year
- 1 to 2 years
- 2 to 3 years
- 3 to 4 years
- 4 to 5 years
- 5 or more years
- SCDHHS Website
- Career Fair(s)
- Information Session(s)
- SCDHHS Employee
- Job Ad(s)
- Higher Education Resource(s)
- SCHA (Hospitalcareers.com)
* Required Question