Health Insurance Analyst, Administrative Specialist 1, Three Positions

Initial Posting Date:
01/19/2024
Application Deadline:
02/11/2024
Agency:
Department of Human Services
Salary Range:
3218.00 - 4755.00
Position Type:
Employee
Position Title:
Health Insurance Analyst, Administrative Specialist 1, Three Positions
Job Description:
The work schedule for these positions is Monday thru Friday, 8:00am - 5:00pm, PST.
We are proud to be an Equal Opportunity Employer. We are actively working to build an equitable agency with the Equity North Star 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 skilled professionals to take on the role of our Administrative Specialist 1, Health Insurance Analyst on our team. 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.
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 ODHS, 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 Equity North Star 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 competitive benefits packages including health, dental, vision and much more!

The key responsibilities of the Health Insurance Analyst will include:

• Independently screening, analyzing, and researching third party resource (TPR) referrals and documentation for completeness, to determine if information provided allows for processing the referral, and if it is appropriate to add into the Medicaid Management Information System (MMIS).
• Utilizing ONE Worker Portal and referral source for client attestation on Domestic Violence cases to determine how to properly process the referral, to avoid creating a safety and/or confidentiality concern for the client(s).
• Explaining laws, rules, and procedures to ensure proper understanding and compliance in determining what TPR information to obtain.
• 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.

What You Need To Qualify - 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.

The ideal candidate will possess a work history that demonstrates the following essential attributes and experience:

• Experience coordinating Health Insurance benefits.
• Experience working with medical billing systems using a computer terminal.
• Experience researching, inputting, updating, and retrieving alpha-numeric data.
• Experience communicating effectively with people over the telephone, in writing and in person.
• Detail oriented and organized.

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.
Working conditions
Typical office/home office environment. Long periods of sitting for phone and computer work. Work is solitary in nature with peer-to-peer interaction limited. Occasional telephone and/or email contact with upset or emotional individuals. Team meetings once a week through MS Teams using cameras, headsets and/or cell phone. Communication with other members of the team is primarily done through MS IM Chat. This position is remote work environment. Though occasional travel to the Salem office for in-person meetings or training may be required.
How to apply

• Your work history profile, cover letter, and resume are the perfect opportunity to highlight your interest in the position and showcase your skills and experience that make you the best candidate for the position.

• Please upload a resume or complete the Workday history profile. Note: Your resume and cover letter may be uploaded in the Resume/CV field on the online application.
• Required: Submit a cover letter that highlights your interest in the position, showcase how you meet the essential attributes and tell us how your experience makes you the best candidate for the position. We read every letter submitted to help us understand your experience related to the position.
• Submit a resume that demonstrates how your experience meets the minimum qualifications.
• Failure to attach a cover letter addressing the essential attributes will result in disqualification of your application.
• Current State of Oregon employees: Apply via your employee Workday account.
• If you are not a current State of Oregon employee: view this application instructional video.
• After you submit your application, be sure to respond to the two questionnaires relating to public records requests and veterans' preference immediately following your submittal. These questions are necessary to complete the application process. Please continue to check your Workday account throughout the recruitment process.

Additional requirements:

• Finalists for this position will be subject to a computerized criminal history and abuse check. Adverse background information will be reviewed and could result in withdrawal of a conditional job offer or termination of employment.
• The Oregon Department of Human Services does not offer visa sponsorship. Within three days of hire, you will be required to complete the US Department of Homeland Security's I-9 form confirming authorization to work in the United States. ODHS will use E-Verify to confirm that you are authorized to work in the United States.

Helpful information

• This position is represented by the Union (SEIU).
• This recruitment may be used to fill future vacancies.
• Have questions about Workday, and want some tips on understanding the state application process? Check out our Oregon job opportunities page.
• IMPORTANT: Please monitor your Workday account as all communications will be sent there.
• The salary listed is the non-PERS qualifying salary range. If the successful candidate is PERS qualifying, the salary range will reflect the additional 6.95%. Please review the Classification and Compensation page for more details, or you may visit our website for information on Pay Equity.
• For questions about the job duties or application process, please contact Nora.L.Leyva-Esquivel@odhs.oregon.gov. Please be sure to include the job requisition number.
• If you need an accommodation under the Americans with Disabilities Act (ADA) to participate in the application or selection process, please contact ADA.DHS@dhsoha.state.or.us. Please be sure to include the job requisition number.

Helpful Links & Resources
How to Set Job Alerts | Workday Applicant FAQ | What You Need to Know to Get the Job
Oregon Job Opportunities Webpage |
We thank you for considering this employment opportunity with the Oregon Department of Human Services.