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Health Insurance Analyst,

3 months ago

Salem, United States State of Oregon Full time
Job Description:

We are proud to be an Equal Opportunity Employer. We are actively working to build an equitable agency with the as our guide toward our vision of an agency free of racism, discrimination and bias. We believe that teams in which everyone can show up as their full authentic self are key to creating a thriving workforce that can better serve communities. We welcome members of historically underrepresented racial/ethnic groups, women, individuals with disabilities, veterans, LGBTQIA2S+ community members, and others to apply.

Opportunity Awaits, Apply Today We're in search of leaders committed to promoting and fostering a diverse and qualified workforce where individuals feel welcome, appreciated, and valued for all they bring to the organization. Administrative Specialists carry out a broad array of administrative and personal assistant tasks, such as conducting research, creating statistical reports and spreadsheets, drafting correspondence, reports, and presentations, as well as managing requests for information. Consider joining our team in a key role as an Administrative Specialist 1, Health Insurance Analyst, within the Office of Payment Accuracy and Recovery (OPAR), for the Oregon Department of Human Services (ODHS).

About the Office of Payment Accuracy and Recovery (OPAR) is part of the Department of Human Services Shared Services Section. Shared Services is also responsible for Facilities; Imaging and Records Management Services; Occupational Health, Safety and Emergent Management; Office of Information Services; Office of Training, Investigations and Safety; Office of Program Integrity; and Publications and Creative Services. OPAR plays a key role in Program Integrity efforts at the department and oversees identification, investigation, and recovery of payments for DHS/OHA programs including Medicaid, TANF, SNAP and others. OPAR is responsible for administering the following statewide programs: Client Overpayment; Client Recovery; Investigations; Estates Recovery; Personal Injury Liens; and Third-Party Recovery (Medicaid).

Oregon Department of Human Services (ODHS), A place to belong and make a difference

  • When you join the , you join a community of over 10,000 employees dedicated to serving and helping Oregonians achieve wellbeing and independence through opportunities that protect, empower, respect choice, and preserve dignity.
  • Connect with ODHS Employee Resource Groups (ERGs) and find a place to belong, build community and participate in shared learning. ERGs are employee-driven committees that support each other as well as the ODHS’ overall mission and vision. 
  • We are committed to building an antiracist and equitable agency. Equity is foundational to our role as a human services agency and we are committed to integrating equity into all we do. The has four points that explain the agency's goals related to equity, inclusion, and racial justice.
  • We know that life is unpredictable and ODHS cares about keeping you well. Enjoy a work-life balance, 11 paid holidays a year, flexible work schedules, and including health, dental, vision and much more


What We Are Looking For, Minimum Qualifications:

  • Two years of secretarial or basic administrative support experience that includes records processing, generating documents, and gathering and sorting data; OR
  • An associate degree in general office occupations and one year of experience with records processing, generating documents, and gathering and sorting data; OR
  • An equivalent combination of education and experience.

Essential Attributes:

  • Experience coordinating health insurance benefits.
  • Experience in operating medical billing systems through a computer terminal.
  • Experience in researching, entering, updating, and retrieving alphanumeric data.
  • Experience in effective communication with individuals through telephone, written correspondence, and face-to-face interactions.
  • Attention to detail experience.

Please be sure to clearly describe how you meet these essential attributes within your application materials. These attributes will be used to determine which candidates will be selected to move forward in the process.  Your application and/or resume will be used when completing a pay equity assessment. The pay equity assessment determines your pay rate/salary step, so complete and detailed work and education history is helpful.

Your duties at a glance

As an Administrative Specialist 1, you will:

In this role you will, ensure that third party resource information for ODHS and OHA clients is entered accurately and timely into the Medicaid Management Information System (MMIS). This unit reviews, researches, analyzes, verifies, and enters third party medical resources, which results in cost avoidance of Medicaid expenditures, recoupment of expenses incurred in error and accurate and timely payment of claims. This unit is also responsible for ending exemptions placed on Medicaid clients that prevent enrollment into Managed Care plans when it is determined that they no longer have an active major-medical third-party resource (TPR). This ensures clients receive the correct level of benefits available to them.

  • Screening, analyzing, and researching third-party resource (TPR) referrals and documentation independently for completeness is crucial to ascertain whether the provided information permits the processing of the referral and if it is suitable for inclusion in the Medicaid Management Information System (MMIS).
  • The ONE Worker Portal and referral source are utilized for client attestation in Domestic Violence cases to ensure the referral is processed correctly, thereby avoiding any safety or confidentiality issues for the client(s).
  • Clarifying laws, regulations, and procedures is crucial to ensure accurate understanding and adherence when determining which TPR information to acquire.
  • Examine and assess the information on websites to ascertain whether it fulfills the criteria for entering TPR into MMIS, or if further information is required to finalize the referral.
  • Explaining HIPAA rules and regulations to insurance carrier representatives outlining why the request for policy information is necessary.
  • Researching insurance carrier websites for TPR information. 
  • Review and analyze information on websites and determine if the information meets the criteria to input the TPR into MMIS, or if additional information is needed to complete the referral.
  • Inputting the insurance eligibility information in the appropriate work queue for accuracy.
  • Creating, revising, and maintaining TPR information in the MMIS system. 

Working conditions:

  • Extended periods of sitting for phone and computer tasks.
  • Work often involves solitary tasks with limited interaction between peers.
  • Team meetings are held weekly via MS Teams, utilizing cameras, headsets, and/or cell phones.
  • Team communication is primarily conducted via MS IM Chat.
  • Remote work will be considered in filling this position.  The ability to report to a local Salem office is required when training, business or operational needs are dependent on onsite activities.