Remote Program Manager Jobs in Lexington, SC (NOW HIRING)

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 Bureau of Provider & Support Services, Richland County. This is an in-office role and not a telecommute or remote position.

Are you the One. We are looking for a Program Manager I (Reference Administration Manager) who reports to the Director of Provider Services and manages reference administration tasks and stakeholder escalations within the Office of Provider Services in accordance with all policies and procedures. This position investigates, defines and resolves complex Medicaid Management Information System (MMIS) issues and maintains a thorough knowledge and understanding of MMIS procedure code and associated pricing, provider/member relations and industry standards.

The Reference Administration Manager understands, fosters, and practices high customer service standards, while interacting with internal and external stakeholders. This includes communicating complex information to both technical and non-technical audiences, facilitating collaboration between stakeholders and supervising staff responsible for MMIS updates. The Reference Administration Manager also establishes milestones and assigns staff tasks and responsibilities; and analyzes, designs, plans, executes, and evaluates agency priorities and initiatives.

Executes quarterly and interim maintenance (addition/deletion/modification) of Medicaid procedure codes and associated pricing in the Medicaid Management Information System (MMIS) within established timelines and according to all state and federal CMS requirements. Collaborates with other Agency areas and MMIS vendor to ensure changes are fully integrated and communicated. Maintains current knowledge of up-to-date state and federal standards regarding medical code sets and application to the Medicaid program.

Monitors and tracks high priority code maintenance requests. Develops logs, tracking tools, and audit trails to track approved changes and/or updates. Develops analytical tools to identify trends and areas of improvement throughout procedure code and pricing update process.

Creates and maintains internal policy and procedure documents related to procedure codes and pricing updates. Oversees implementation of policies and procedures and ensures appropriate use. Develops and delivers Bureau and Agency-wide training on procedure code and pricing updates.

Leads testing for MMIS, Provider Claims Portal (i.e., Webtool), Provider Enrollment site, and EDI Transactions. Communicates and shares pertinent and timely information to direct reports by holding team meetings, scheduling regular 1:1 employee discussion, reinforcing leadership messages. Directly supervises Reference Administration staff, including contractors

Carries out management responsibilities in accordance with the organization's policies and applicable laws. Responsibilities include interviewing, hiring, and training employees; planning, assigning, and directing work; establish performance standards; appraising performance; rewarding and disciplining employees; addressing complaints and resolving problems. Demonstrates leadership by serving as a positive role model and creates an environment of team engagement.

Ensures open communication with team and maintains an open door policy for employee engagement, communication, and coaching. Serves as Subject Matter Expert (SME) for procedure code-related projects and initiatives. Provides daily support and guidance to internal teams, including leading coordination with Bureau of Policy on changes, providing QA support for bulletin reviews.

Attend and participate in relevant opportunities for professional development and training. Demonstrate utilization and application of new skills learned to improve effectiveness and efficiency within assigned responsibilities. Participate as a project team member, as needed, or assigned, to support reference administration interests and bureau priorities aligned with strategic goals and agency mission and objectives.

Other duties, as assigned, i.e., pilot projects, mentor to new hires, lead role for improvement efforts (not a formal project) and to assist other teams within and outside of our bureau. When requested, participate in events or projects that promote better efficiency, effectiveness and/or teamwork. 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 Bachelor's degree in Health Information Management, Healthcare Administration, or a related field and relevant program experience. An equivalent combination of experience and education may be considered with prior State Human Resources approval.

Equivalent experience may be considered with a minimum of three (3) years of direct supervisory experience. Additional Requirements: Valid driver's license. Sitting or standing for long periods of time.

In-office role. Preferred Qualifications Knowledge of the SCDHHS mission, programs and objectives. Knowledge of management principles.

Demonstrated ability to communicate professionally and effectively orally and in writing. Ability to interpret and apply rules and regulations. Ability to manage work and provide guidance to employees.

Ability to make presentations and prepare reports. Understanding of Medical coding set, CMS standards, and application of codes to insurance systems. 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.