Medical Claims Specialist

Healthy and Safe Communities Section - Remote in North Dakota - Medical Claims SpecialistSpecial Health Services (SHS) works to promote a system of care that improves the health and well-being of children with special health care needs. The SHS Financial Coverage Program provides financial coverage for services to children with special or chronic health conditions who meet eligibility criteria. As a Medical Claims Specialist for the SHS Unit, you will be responsible for reviewing and processing medical and dental claims for the SHS Financial Coverage Program, providing administrative support, excellent customer service, perform general office management, program administrative support, demonstrate attention to detail and accuracy related to data collection, data entry, and report writing. You will complete duties including: Review a variety of claims; adjudicate claims and adjustments submitted to SHS according to established policies, procedures, guidelines, and federal and state lawsReview client information to determine if the client is eligible for the submitted services based on the SHS Policy, Procedures, and Resource Manual Respond to questions and provide support to providers, families, and other staff members (e.g., health benefits counseling, eligibility guidance, assistance with provider enrollment, and information requests, etc.)Collaborate with partners on issues or policy changes based on information from providers and other stakeholdersSubmit cleft lip and palate clinic claims to North Dakota Medicaid on behalf of SHS Lead and maintain record retention efforts for the SHS Unit and taking responsibility for appropriate disposal of confidential filesProvide various administrative office duties (e.g., back-up for SHS phone coverage when requested, data entry, composing general office correspondence, collaborating with other SHS staff to meet business needs, etc.). Conduct Newborn Screening Long-term Follow-up phone calls to assist with navigation of health benefits, medical bills, etc.Assist with contract monitoring and tracking To thrive in this position, you must be able to work independently as well as in groups, have the ability to handle multiple, detailed tasks and to establish and maintain cooperative working relationships with staff. Applicants must have excellent telephone and written communication skills and the proven ability to deal with the public and co-workers in a courteous manner. This job requires knowledge around claims processing and skills in the use of word processing software, spreadsheets, databases, e-mail, and the Internet. To be considered for the Medical Claims Specialist position, you are required to have two years of college level courses and one year experience performing medical claims processing. Additional work experience performing claims processing may substitute for the education requirements on a year-for-year basis. Preference will be given for medically related office experience or coursework.This position requires a valid driver's license and successful completion of the assigned defensive driving course during new-hire orientation.About HHS:The North Dakota Department of Health and Human Services (HHS) provides services for all North Dakotans that reinforce the foundations of wellbeing - economic, behavioral, and physical health. Those services and care are to be delivered as close to home as possible with a focus on dignity and respect. The key to delivery of those services is the nearly 3000 committed, compassionate individuals who work for ND HHS. The largest agency in the State, work is funded by more than $6 billion from nearly 200 different federal, state, and special sources.Location:ND HHS utilizes a blended workplace model. This position may work from anywhere within North Dakota with the ability to travel for occasional meetings.

About Team ND

"Far and away the best prize life offers is the chance to work hard at work worth doing." - Theodore RooseveltMore than 7,500 talented, hard-working people across sixty-three agencies have come together as Team North Dakota. At Team ND, we are driven to succeed through gratitude, humility, curiosity and courage. Our purpose is to empower people, improve lives, and inspire success. Join us in being legendary.Total Rewards: The State of North Dakota is committed to providing team members with a strong and competitive rewards package that support you, your health and your family.Considering a new position on Team ND? How does your current position stack up? Use our Total Rewards Calculator to estimate.

325 HHS Application Procedures

Your resume should include information to demonstrate how you meet the minimum qualifications as posted. If the Department's Human Resource Division is unable to determine that you meet the minimum qualifications, credit will not be given. All application material must be received on or before the closing date by 11:59 pm.Applicants must be legally authorized to work in the United States. The Department of Health & Human Services does not offer or provide sponsorships.This employer participates in E-Verify. Please visit the following website for additional information: https://www.hhs.nd.gov/careers/e-verifyA copy of your qualifying degrees transcript and any applicable certifications or licensures must be provided at the time of an interview.For more information about the position or if you need an accommodation, please contact Kimberly Hruby at krhruby@nd.gov or at 701.328.4854.Employing Unit: ND HHS - Healthy and Safe Communities SectionTTY Number: ND Relay Service 1-800-366-6888 (text); 1-800-366-6889 (voice)If you are experiencing technical difficulties with the Application Process or uploading attachments, please contact recruiter@nd.gov or (701)328-3290.

Equal Opportunity Employer

The State of North Dakota and this hiring agency do not discriminate on the basis of race, color, national origin, sex (including sexual orientation and gender identity), genetics, religion, age or disability in employment or the provisions of services and complies with the provisions of the North Dakota Human Rights Act.As an employer, the State of North Dakota prohibits smoking in all places of state employment in accordance with N.D.C.C. Sect. 23-12-10.