Coordinator II - Eligibility & Coverage Services

Recruitment #220628-UNCE-378

Introduction

This position is open ONLY to OHCA Staff and/or Contractors.

Coordinator II - Eligibility and Coverage Services

POSITION REQUIREMENTS:
Under the direction of Member Services Manager and the assistance of Coordinator III, researches and resolves tier II member and agency partner issues related to the Medicaid program in a timely manner.  This position will work with SoonerCare members, health care providers, service organizations, agency enrollment partners, and other stakeholders to develop strategies and implement policies for the SoonerCare program in a call center environment.  Job duties to be performed are prone to different methods of solution and require flexibility in interpreting the appropriate method to complete the assignment. The individual in this position will be responsible for assuring the timely resolution of member, provider, applicant, and agency enrollment partners regarding SoonerCare program concerns and eligibility & enrollment.

COORDINATOR I PRINCIPLE ACTIVITIES: 
- Answers incoming tier II telephone inquiries from members, vendors, county offices, outside agencies, agency enrollment partners, and others. Requires individual research and interpretation of federal rules and procedures and agency policy and rules in relation to the SoonerCare program and Eligibility Determinations.  Research involves multiple PC screens which includes MMIS, DHS, Atlantes and other agency systems and requires the use of document imaging software.
- Researches and resolves member issues related to the SoonerCare program and eligibility determinations as identified in inquiries, access to care issues, complaints (fraud and abuse, and quality assurance), e-mail, eligibility documents, written correspondence, and telephone calls. Initiates action necessary to resolve issues which encompasses outbound calling and eligibility discrepancies.
- Educates members, vendors, county offices, outside agencies, agency enrollment partners, and others on SoonerCare program coverage and services as well as eligibility & enrollment guidelines.
- Identify and reports system discrepancies via helpdesk ticket or email.
- Keeps updated on constantly changing SoonerCare rule revisions, as well as the SoonerCare Program and Eligibility Determinations revisions in order to provide accurate, current information to providers, members, agency enrollment partners, OHCA employees and others in the health care community.  Reference materials must be organized and accessible at all times.
- Reviews, analyzes and processes workflow documents.
- Align members with the appropriate provider, and analyze provider file for accuracy.
- Attends meetings with agency personnel and other officials.  Represents OHCA as needed in seminars and training forums.
- Identify, assist and resolve claim reconciliation, and verify CPT coverage according to the SoonerCare program.
- Other duties as assigned.

COORDINATOR II (IN ADDITION TO LEVEL I PRINCIPLE ACTIVITIES)
- Identifies potential operational and contractual issues and participates in the formulation of procedures to resolve conflicts or provide clarification, which includes referrals to the appropriate departments or other agencies.
- Independently communicates and resolves issues with members and other stakeholders regarding the SoonerCare program as identified in daily reports, written correspondence, and telephone calls.
- Assists in maintaining workflow during staff absences and heavy call volume.
- Maintains and updates written controls of materials received, routed, assigned; maintains member letters, instructions, guidelines and similar materials requiring rapid retrieval and presentation.
- Participates in member outreach, enrollment, educational, and marketing efforts.
- Other duties as assigned

TRAVEL: Travel on an “as needed” basis.

ACCOMMODATION STATEMENT:
The Oklahoma Health Care Authority complies with applicable Federal civil rights laws and does not discriminate.  All qualified applicants will receive consideration for employment without regard to race, color, sex, religion, disability, age, national origin, or genetic information. If a reasonable accommodation is needed to participate in the job application or interview process, to perform essential job functions, and/or to receive other benefits and privileges of employment, please contact the Civil Rights Coordinator at 405-522-7335.

MINIMUM QUALIFICATIONS

KNOWLEDGE AND BACKGROUND REQUIREMENTS
QUALIFICATIONS:
To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. 

The requirements listed below are representative of the knowledge, skill and/or ability required. 

COORDINATOR I
EDUCATION AND/OR EXPERIENCE: 
- Associates degree AND
- Six months of Medicaid eligibility experience which includes interpretation and understanding of the MAGI method for determining Medicaid eligibility and knowledge of Medicaid operational procedures affecting internal and external entities OR
- An equivalent combination of education and experience totaling 2 ½ years 

COORDINATOR II
EDUCATION AND/OR EXPERIENCE: 
- Associates degree AND
- Eighteen months of Medicaid eligibility experience which includes interpretation and understanding of the MAGI method for determining Medicaid eligibility and knowledge of Medicaid operational procedures affecting internal and external entities OR
- An equivalent combination of education and experience totaling 3 ½ years

PREFERENCE MAY BE GIVEN TO CANDIDATES WITH:
- Bilingual in Spanish and English
- Knowledge of principles and practices of Oklahoma Department of Human Services Family Support Services
- Knowledge of principles and practices of SoonerCare operations and/or Insure OK
- Knowledge of principles and practices of Medicaid Eligibility Determinations
- One year of call center experience
- Current employee in the Tier II Eligibility group

NOTES

Please read instructions carefully and include all required documents when you submit your application.

No additional information will be accepted after the application has been submitted.