Research & Resolution Specialist

1 month ago

Oklahoma City, United States State of Oklahoma Full time

Job Posting Title

Research & Resolution Specialist

Agency

090 OFFICE OF MANAGEMENT AND ENTERPRISE SERV

Supervisory Organization

EGID

Job Posting End Date (Continuous if Blank)

May 27, 2024

Note: Applications will be accepted until 11:59 PM on the day prior to the posting end date above.

Estimated Appointment End Date (Continuous if Blank)

Full/Part-Time

Full time

Job Type

Regular

Compensation

Job Description

As a Research & Resolution Specialist with OMES you will enjoy:

* Generous leave including 15 days of vacation, 15 days of sick leave and 11 paid holidays annually.
* A comprehensive Benefit Package with a generous benefit allowance to offset the cost of insurance premiums for employees and their eligible dependents.

Job Details

* Full-time 40-hour work weeks.
* Support the Employee Group Insurance Division
* Salary up to: $52,900.00

Responsibilities

* Handle urgent and non-urgent member and dependent eligibility and premium accounting referrals within accuracy ranges and required time constraints, adhering to all unit procedures and EGID rules and regulations.
* Correctly process Medicare changes and notifications within accuracy ranges and required time constraints, in compliance with current Center for Medicare & Medicaid Services (CMS) Part D Program (PDP) Guidance, EGID rules and regulations and all unit procedures.
* Process eligibility updates from Third Party Administrators within the accuracy ranges and required time constraints, in compliance with current CMS PDP Guidance, EGID rules and regulations and all unit procedures.
* Process recurring small reports (MAPD Monthly Reports) within accuracy ranges, in compliance with current CMS PDP Guidance, EGID rules and regulations and all unit procedures.
* Process recurring large reports (CVS Reconciliation Reports) within accuracy ranges, in compliance with current CMS PDP Guidance, EGID rules and regulations and all unit procedures.
* Process special projects within the accuracy ranges, in compliance with current CMS PDP Guidance, EGID rules and regulations and all unit procedures.
* Reviews and analyzes discrepancy reports for various types of insurance or benefits, such as health, dental, life and vision insurance.
* Process Non-Compliant Forms, Enrollment Forms, Change Forms, Termination Forms and other assigned correspondence within accuracy ranges, adhering to all unit procedures and EGID rules and regulations.
* Understands and adheres to HIPAA Compliance and Fraud, Waste and Abuse policies and successfully complete annual trainings for compliance.

Physical Demands and Work Environment

* This position works in a comfortable office setting with a large percentage of the work day done on a computer and telephone. The noise level is usually mild. Ability to occasionally lift paper and office supplies and to perform job duties on a computer and telephone for 6-8 hours per day is necessary. Occasional travel may be required.

Minimum Qualifications

* A bachelor's degree; two years of experience in bookkeeping work, insurance eligibility determination or closely related work; two years of experience in the maintenance, analysis and reconciliation of insurance or benefits accounts; or a combination of education and experience.

About OMES

The Office of Management and Enterprise Services provides excellent service, expert guidance and continuous improvement in support of our partners' goals. We are a highly qualified workforce committed to serve those who serve Oklahomans and make government run in the most efficient, innovative manner possible.

OMES is an Equal Opportunity Employer. Reasonable accommodation to individuals with disabilities may be provided upon request.

Equal Opportunity Employment

The State of Oklahoma is an equal opportunity employer and does not discriminate on the basis of genetic information, race, religion, color, sex, age, national origin, or disability.

Current active State of Oklahoma employees must apply for open positions internally through the Workday Jobs Hub.

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