EEMS Quality Review Specialist, Team Lead (Program Coordinator I) / 60015020 Position Available In Greenville, South Carolina

EEMS Quality Review Specialist, Team Lead (Program Coordinator I) / 60015020

Salary
$38,985.00

• $72,134.00 Annually
  Location Statewide, SC
  Job Type
  FTE
• Full-Time
  Job Number
  175347
  Agency
  Department of Health and Human Services
  Division
  Eligibility Quality Assurance
  Opening Date
  04/10/2025
  Closing Date
  4/17/2025 11:59 PM Eastern

Class Code:

AH35

Position Number:

60015020

Normal Work Schedule:

Monday

• Friday (8:30
• 5:00)
  Pay Band
  Band 5
  Hiring Range
• Min.
  $40,135.00
  Hiring Range
• Max.

$40,135.00
Opening Date
04/10/2025
EEO Statement
Equal Opportunity Employer

Agency Specific Application Procedures:

Failure to provide detailed and complete information may result in your application not being referred.
Veteran Preference Statement
South Carolina is making our Veterans a priority for employment in state agencies and institutions.

DESCRIPTION

BENEFITS
QUESTIONS
Job Responsibilities
The Agency’s mission is to be boldly innovative in improving the health and quality of life for South Carolinians.
This is position is located in Eligibility Quality Assurance, Statewide.
Are you the One? We are looking for a EEMS Quality Review Specialist who serves as team lead for the MAGI Eligibility Quality Assurance Team and is responsible for re-reviewing and dispositioning cases within the Quality Tool. The Quality Review Team Lead will evaluate the accuracy of eligibility determinations made by Quality Reviewers. They will ensure that all quality review determinations are accurate and completed in a timely manner.
In accordance with the timeliness standards set by the department, perform a high-level check on re-reviewed cases for accuracy. If both re-reviewers agree it is a failed case, check to ensure it is a failed case and that the error code and explanation is correct, clear, and concise. If both re-reviewers agree it is a pass, check to ensure it is a passed case. Consult with the original reviewer to go over the mistake. If the re-reviewers disagree, check the case to determine the appropriate outcome and meet with the re-reviewers to discuss the case.
Update records and maintain final case outcome compilations for EQAT Management. Compose and submit rebuttal responses as needed. Edit any cases overturned by Rebuttal committee in the Quality Tool.
Compile, assign and complete Fail case corrections and Pass case escalations at the end of each review cycle. Complete spot checks in the system of record (SOR) to ensure corrections were made from failed cases and escalations.
Assist EQAT staff with policy, review scope, systems, and/or other case related questions. Assist with the training of EQAT reviewers.
Maintains a professional demeanor and communication style, ensuring that communication and interactions with internal and external stakeholders 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. Attend all mandatory meetings, training courses and events as directed by supervisory staff and agency leadership. Maintains awareness of and complies with all agency policies, including 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.
The South Carolina Department of Health and Human Services offers an exceptional benefits package for FTE and TGE positions that includes:
Health, Dental, Vision, Long Term Disability, and Life Insurance for Employee, Spouse, and Children.
15 days annual (vacation) leave per year.
15 days sick leave per year.
13 paid holidays.
State Retirement Plan and Deferred Compensation Programs.
Minimum and Additional Requirements
A high school diploma with two (2) years of processing Medicaid applications, and one (1) year as a quality reviewer. Must have exceptional attention to detail with at least one (1) year of experience managing data.

Preferred:

Proven leadership skills.

Additional Requirements:

Sitting or standing for long periods of time.
Overtime and/or weekend work with Deputy approval.
Lifting requirements: 20 lbs.
Occasional overnight travel.
Preferred Qualifications
Knowledge of Medicaid laws, regulations, policies and procedures. Ability to interpret and apply laws, regulations, policies and procedures. Ability to learn, retain, and apply information about federal rules and standards for reviewing Medicaid eligibility determinations. Ability to exercise judgment and discretion. Ability to establish and maintain effective working relationships. Ability to communicate effectively in writing and orally. Familiarity with computers, standard Microsoft Office software and internet browsers. Ability to perform basic mathematical computations. Ability to work in a professional office environment with a diverse group of teammates.
Additional Comments
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 online. 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.
Employer
State of South Carolina
Agency
Department of Health and Human Services
Address
1801 Main Street, Suite 224
Columbia, South Carolina, 29201
Phone
803-898-2670
THE

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