Program Coordinator II (Quality Review Specialist) / 60020122

Program Coordinator II (Quality Review Specialist) / 60020122

Salary

$52,100.00 - $54,000.00 Annually

Location

Richland County, SC

Job Type

FTE - Full-Time

Job Number

191339

Agency

Department of Health and Human Services

Division

Bureau of Provider and Support Services

Opening Date

08/05/2026

Closing Date

8/18/2026 11:59 PM Eastern

Class Code:

AH40

Position Number:

60020122

Normal Work Schedule:

Monday - Friday (8:30 - 5:00)

Pay Grade

GEN09

Hiring Range - Min.

$52,100.00

Hiring Range - Max.

$54,000.00

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 Agencys 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 Coordinator II (Quality Review Specialist) who supports the successful delivery of quality control and audit functions for claims processing within the Bureau of Provider and Support Services. Works under general direction reporting to the Director of Support Services. Identifies and responds to claims related audits, external reviews, and internal quality control functions for claims processing for Fee For Service and Waiver beneficiaries specifically for Long Term Care (LTC), Hospice and Nursing Home Claims. Has sound general, domain and specific knowledge of claims processing and demonstrates application of this knowledge. Applies methodical approach(es) to issue definition and resolution. Demonstrates effective communication skills. Demonstrates excellent customer service. Plans, schedules, and monitors own work within deadlines according to management.

• Develops Bureau-wide quality control plan and dashboard to include production and quality metrics for staff completing claims and provider services functions. Fosters a Bureau-wide commitment to quality assurance. Performs data collection, data analysis methodology, and implements performance improvement methods. Leads performance improvement projects and provide education and coaching in order to build needed skills in others. Coordinates with directors/managers to ensure continuous improvement efforts are integrated into all offices and sections, including staff responsibilities.
• Serves as the Bureau Lead for all audits (including internal, single state, PERM, etc.). Collaborate with stakeholders both within and outside of the Bureau to ensure all audit requests are completed timely and meet all requirements. Upon completion of audit, work with Bureau Directors to address any deficiencies and create corrective action plans to regain compliance.
• Serves as Bureau Lead for performing quality control audits of claims and provider services staff utilizing a combination of system reports and random sampling. Perform trend analysis for any repeat errors and collaborate with Bureau Director for remedial training of staff.
• Prepares reports and presents to management and external stakeholders related to processes, measures and outcomes, advising management of findings and recommendations. Leads organization toward a culture of continuous improvement.
• Manages special projects as directed by the Bureau Chief of Provider Services and Support related to the development and improvement of services within the Medicaid health care delivery system.
• Attends and participates in relevant opportunities for professional development and training. Demonstrates utilization and application of new skills learned to improve effectiveness and efficiency within assigned responsibilities.

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 bachelors degree and one (1) year of relevant program experience.

An equivalent combination of education and experience may be accepted with prior State Human Resources approval.

Additional Requirements:

• Valid drivers license.
• Occasional overnight travel.
• Sitting or standing for long periods of time.
• Lifting requirement: 20 lbs.
• In-office role.

Preferred Qualifications

• Ability to work independently; to organize and complete work assignments based on level of priority and importance and take appropriate action with minimal guidance.
• Ability to maintain a positive working environment with internal and external relationships.
• Capable of following oral and written policies/regulations.
• Must be able to maintain a strict level of confidentiality.
• Advanced skills with applications such as Microsoft Word and Excel.
• Knowledge of laws, regulations, policies and procedures relevant to the claims processing and related services for Hospice, LTC and Nursing Homes.
• Ability to exercise judgment and discretion.
• Ability to establish and maintain effective working relationships.
• Ability to interpret and apply laws, regulations, policies and procedures.
• Ability to communicate effectively.

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.

Benefits for State Employees

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.

Insurance Benefits

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.

Retirement Benefits

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.

Workplace Benefits

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.

01

The responses you provide to these Supplemental Questions will be used in combination with your application to determine whether you meet the minimum qualification requirements. Please, thoroughly complete the Education and Work Experience sections of your application and the Supplemental Questions. Failure to provide detailed and complete information will result in your application being rejected. Any misrepresentation or omissions will result in your disqualification from employment and/or termination. You may not submit resumes in lieu of filling out the application or answering the Supplemental Questions. I acknowledge that I have read, understand, and agree with the above.

• Yes
• No

02

The established hiring range for this position is $52,100 to $54,000. Do you accept this range?

• Yes
• No

03

Do you have a bachelors degree?

• Yes
• No

04

Do you have one (1) year of relevant program experience?

• Yes
• No

05

Do you have healthcare claims processing or payment operations experience? If yes. briefly describe your healthcare claims processing or payment operations experience ("see resume" is not an acceptable response and could result in disqualification).

06

Do you have any previous experiences with auditing or quality control?

• Yes
• No

07

Do you have a valid drivers license? If yes, please provide your drivers license number and state of issuance.

08

Do you wish to claim Veteran Preference? If yes, you must submit a copy of your DD214 Form with your job application in order to qualify and claim this preference.

• Yes
• No

09

How did you hear about this career opportunity?

Required Question

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 language used in this document does not create an employment contract between the employee and the agency. This document does not create any contractual rights or entitlements. The agency reserves the right to revise the content of this document, in whole or in part. No promises or assurances, whether written or oral, which are contrary to or inconsistent with the terms of this paragraph create any contract of employment.