<p>Job Responsibilities</p> <p>The Agency's mission is to be boldly innovative in improving the health and quality of life for South Carolinians.</p> <p>This is position is located in the Bureau of Provider & Support Services, Richland County.</p> <p>Are you the One? We are looking for a Provider Enrollment Coordinator who primary responsibilities include provider enrollment application quality reviews, assistance including both initial enrollment and revalidations. Works collaboratively with coworkers, supervisory staff, and Executive Leadership to ensure Medicaid provider enrollment management and maintenance functions are carried out and adhered to according to CMS and SCDHHS guidelines and policies. The Program Coordinator serves as a liaison and communications lead between the vendor and agency stakeholders. Serves as a subject matter expert in providing knowledge and expertise for participating providers in the South Carolina Medicaid Program. Completes reporting and other evaluation analysis to track and measure provider enrollment processing metrics.</p> <ul> <li>Responsible for processing Medicaid provider applications that require SCDHHS handling. This includes both initial applications and revalidations. Works with provider applicant and internal areas to facilitate review and approval of Medicaid provider enrollment applications ensuring that agency goals and published timelines are met. Serve as subject matter expert able to field questions and assist internal stakeholders in all matters related to Medicaid provider enrollment. </li><li>Follow standard procedures to view fingerprint based criminal background check reports. Complete examinations of digital items involved in FCBC cases. Verify provider is eligible to participate in Medicaid according to CMS guidelines. Coordinate, process, and maintain requests for access to the SLED background check database, assisting applicants with successfully gaining access and researching provider file issues to assist providers with resolving those problems. Track processing time for each applicant and ensure applicants are processed in appropriate order. Reviews provider applications to determine applicant eligibility based on a predetermined set of standards. </li><li>Responsible for review and approval of all Medicaid provider submitted EFT change requests. Using most current industry standards and SCDHHS policies and procedures, reviews and assesses EFT change requests to determine validity and accuracy. Works with Medicaid provider enrollment vendor via document repository system to communicate and route work requests and approvals. </li><li>Performs other duties as assigned adhering to all program, agency, State and other related policies, procedures, privacy and timeline standards. </li><li>Demonstrate a knowledge of relevant policies and procedures that impact provider application processing, contract, claims adjudication reimbursement and general inquiry and escalation decision points. Identify potential conflicts and share information with team and supervisor to eliminate delays and need for additional processing steps. In addition, adhere to management policies and procedures, business process improvement, and performance requirements within guidelines. </li><li>Meets professional development goals as assigned by management. Participates in cross training opportunities. Coordinates the creation of individual professional development plan with manager. Monitors progress toward continuing professional development. </li></ul> <p>The South Carolina Department of Health and Human Services offers an exceptional benefits package for FTE and TGE positions that includes:</p> <ul> <li>Health, Dental, Vision, Long Term Disability, and Life Insurance for Employee, Spouse, and Children. </li><li>15 days annual (vacation) leave per year. </li><li>15 days sick leave per year. </li><li>13 paid holidays. </li><li>State Retirement Plan and Deferred Compensation Programs. </li></ul> <p>Minimum and Additional Requirements</p> <p>A bachelor's degree and one (1) year of experience in healthcare application processing or healthcare related escalation support.</p> <p>An equivalent combination of experience and education may be considered with prior State Human Resources approval.</p> <p>Healthcare Customer Service Experience, preferred.</p> <p>Additional Requirements:</p> <ul> <li>Sitting or standing for long periods of time. </li><li>Lifting requirements: 20 lbs. </li></ul> <p>Preferred Qualifications</p> <ul> <li>Must be able to move efficiently between multiple tasks with a high degree of accuracy. </li><li>Ability to work independently; to organize and complete work assignments based on level of priority and importance and take appropriate action with minimal guidance. </li><li>Ability to maintain a positive working environment with internal and external relationships. </li><li>Capable of following oral and written policies/regulations. </li><li>Must be able to maintain a strict level of confidentiality. </li><li>Advanced skills with applications such as Microsoft Word and Excel. </li></ul> <p>Additional Comments</p> <p>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.</p> <p>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.</p>