C/S Health Care Cost Containment Specialist

Make a Difference with DHSS

Our mission at the Department of Health and Social Services (DHSS) is to improve the quality of life of Delaware citizens by promoting health and well-being, fostering self-sufficiency, and protecting vulnerable populations. We prioritize personal and family independence by assisting individuals and families in a variety of life areas.

We offer numerous career opportunities and are dedicated to attracting and retaining highly talented individuals who are ready to make a difference in their community today. DHSS is a great place to kick-start your profession.

For more information, please visit https://dhss.delaware.gov/dhss/ today!

The incumbent in this position will assist Community Health Clinics in all three counties with insurance credentialing and provider enrollment activities in collaboration with administrative staff and insurance companies. The position reviews insurance claim denials in correlation with client electronic medical record (EMR) documentation to identify discrepancies, support reimbursement, and improve claims resolution. Maintains records, communicates with insurance carriers, and supports operational efficiency through coordination and adherence to clinic processes and procedures.

Essential functions are fundamental, core functions common to all positions in the class series and are not intended to be an exhaustive list of all job duties for any one position in the class. Since class specifications are descriptive and not restrictive, incumbents can complete job duties of similar kind not specifically listed here.

• Serves as Department's technical expert in the highly complex areas of health care cost containment.
   
• Manages, directs and/or performs specialized studies which result in alternative health care delivery systems and methodologies.  Supervises staff as needed when directing any project.
   
• Provides technical expertise to other Divisions, within the Department, in the areas of policy development, research and evaluation, reimbursement methodologies and health care cost containment initiative.
   
• Collects and analyzes varied and complex data used in support of report, project and funding development purposes.
   
• Serves on or coordinates special committees, task forces, and working groups involved in strategic planning, policy development, service delivery and cost containment projects for the Department.
   
• Analyzes reports and documents from federal, state and the department and recommends cost containment policy changes.
   
• Prepares annual legislative Health Care Cost Containment Report which outlines the Department activities in this area.
   
• Keeps abreast of legislative and technical developments and change related to the area.
   
• Works with other state, local or private agencies that are affected by cost containment policy changes

JOB REQUIREMENTS for Health Care Cost Containment Specialist
Applicants must have education, training and/or experience demonstrating competence in each of the following areas:

1. Three years experience in health care cost containment such as analyzing health care costs and recommending delivery systems and reimbursement procedures.
2. Six months experience in developing policies and procedures.
3. Six months experience in interpreting health care laws, rules, regulations, standards, policies and procedures.
4. Six months experience in health or human services program administration such as overseeing and directing the development, implementation and evaluation of health or human services programs and services; planning and establishing short and long range program goals and objectives. Providing advice to other agency organizational units through consultation.
5. Knowledge of managing budgets, grants or contracts.
6. Knowledge of staff supervision acquired through course work, academic training, training provided through an employer, or performing as a lead worker overseeing the work of others; OR supervising staff which may include planning, assigning, reviewing, and evaluating the work of others; OR supervising through subordinate supervisors a group of professional, technical, and clerical employees.

This is a Casual/Seasonal position which is a non-pension eligible position without healthcare and/or other benefits.

Applicants must be legally authorized to work in the United States. The State of Delaware participates in E-Verify and will provide the federal government with your Form I-9 information to confirm that you are authorized to work in the U.S. For more information refer to our Job Seeker Resources.

DHSS does not provide employment-based sponsorship.

All new hires are required to report to the Statewide New Employee Orientation (SNEO) on their first day of employment. Sessions are held at designated locations in Kent or New Castle County.

The application and supplemental questionnaire are evaluated based upon a rating of your education, training and experience as they relate to the job requirements of the position.  It is essential that you provide complete and accurate information on your application and the supplemental questionnaire to include dates of employment, job title and job duties.  For education and training, list name of educational provider, training course titles and summary of course content.   Narrative information supplied in response to the questions must be supported by the information supplied on the application including your employment, education and training history as it relates to the job requirements.

Once you have submitted your application on-line, all future correspondence related to your application will be sent via email.  Please keep your contact information current.  You may also view all correspondence sent to you by the State of Delaware in the “My Applications” tab at StateJobs.Delaware.gov.

Accommodations are available for applicants with disabilities in all phases of the application and employment process. 

Individuals who use TDD may request auxiliary aid or service by calling (800) 232-5470 or by visiting delawarerelay.com. 

If you need assistance with an accommodation under the Americans with Disabilities Act (ADA) or general applicant support, you may call (302) 739-5458 or email jobs@delaware.gov.

The State of Delaware is an Equal Opportunity employer and values a diverse workforce. We strongly encourage and seek out a workforce representative of Delaware including race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression.