Job Title (Date):
Senior Health Care Auditing Specialist (June 2024)
Department:
Health Care Services
Employee Type:
Full-time
Reports to:
Supervisor – Health Care Systems & Reporting
FLSA Status:
Non-Exempt
Travel Required: 5%
Supervisory Responsibility:
None
Salary Range: $47,611 - $66,655
Posting Period:
June 14, 2024 – June 27, 2024
*Typically, initial wage is set between the minimum and the midpoint of the salary range depending on the employee’s qualifications and experience.
Summary of Responsibilities:
The Senior Health Care Auditing Specialist is responsible for providing excellent customer service in responding to member inquiries and requests, assisting in acknowledging and enrolling plan participants in the health care program, documenting all transactions, communicating with benefit recipients/vendors/governmental agencies, serving as auditor for review of benefit recipient transaction accuracy; accepting complex customer service calls; functioning as a subject matter expert for eligibility and coverage related questions as well as department operations.
The Senior Health Care Auditing Specialist also serves as back up for the Health Care Specialists, and Health Care Systems & Reporting Supervisor, as requested.
Essential Duties and Responsibilities:
- Provides high quality customer service.
- Responds to all member inquiries by phone, mail or e-mail.
- Assists Members/Retirees on incoming and outgoing calls.
- Accepts and resolves complex customer service calls.
- Documents all business transactions.
- Audits and processes changes in plan enrollment, dependent, name, refunds, and other benefit recipient related transactions for accuracy and completeness.
- Processes and trains staff on multiple enrollment processes and reports
- Assign work processing and auditing
- Manage work distribution
- Assist in ensuring processing, auditing, and Member Service requests are completed and meet deadlines.
- Resolves CMS related issues from vendors.
- Tracks and reports vendor issues
- Reports trends of potential problems from phone calls and processing.
- Assists Members/Retirees in office.
- Prepares outgoing mail and correspondence, including email and faxes.
- Represents SERS at member and retiree meetings.
- Identifies and communicates department issues and participates in resolution.
- Serves on committees and work groups as requested
- Represents department as needed for various initiatives and projects.
- Maintains knowledge of health care coverage through attending department staff meetings, in-service education, and self-learning
- Serve as backup to the Health Care Specialists.
- Serve as backup to Senior Health Care Administrative Specialist
- Serve as backup to Health Care Systems & Reporting Supervisor, as needed
- Offer suggestions for process improvement
- Assists with staff training as needed.
- Other responsibilities as assigned.
Educations and Skills/Qualifications:
- Associate’s degree (A.A.); or
- Three or more years related experience and/or training related to health insurance or benefits
- Demonstrates a positive team-focused perspective and attitude.
- Excellent problem-solving skills.
- High attention to detail and accuracy.
- Task, timeline, and results oriented.
- Efficient time management skills.
- Ability to use computers effectively and efficiently.
- Effective oral and written communication skills.
- Ability to build and maintain effective relationships
- Proficient in Microsoft Office applications.
- Equivalent combination of education and experience.
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, skills, and abilities required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
Working Conditions:
This role operates in a professional office environment and is subject to prolonged periods of sitting or standing at a desk and working on a computer. This role routinely uses standard office equipment such as computers, phones, photocopiers, filing cabinets and fax machines and may need to be able to lift up to 10 pounds at times. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. The noise level in the work environment is usually moderate.
The hours for this position are from 8:00 a.m. to 4:45 p.m.Health Care Services staff members are eligible to work remotely 2 days per week, after training and 30 days of employment. Remote working days are not guaranteed and subject to change based on organizational needs.
Competencies:
SERS Specific:
Focus - Dedicated to meeting the needs of customers both internal and external. Talks, acts, and makes decisions with customers in mind. Accountability - Takes responsibility for all work activities and personal actions; follows throughon commitments, implements decisions that have been agreed upon; maintains confidentiality with sensitive information; acknowledges and learns from mistakes without blaming others. Recognizes the impact of one’s behavior on others.Communication - Creates an environment of open, direct and proactive communication, both written and verbal.
Is unafraid to communicate freely across layers of the organization.Collaboration- Develops cooperation and teamwork while participating in a group, working toward solutions which generally benefit all involved parties.Innovation - The commitment to search for and create new and innovative approaches to activities that enhances performance. Is willing to change.
Position Specific:
Note: While performing the duties of this job, the employee is regularly required to sit, stand, walk, and lift up to 10 pounds. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. The noise level in the work environment is usually moderate. SERS is an equal employment opportunity employer.Disclaimer: This job posting is not meant to be all-inclusive and the position itself is subject to change.SERS is an Equal Employment Opportunity Employer.
We recruit, hire, train, and promote without discrimination due to age, race, color, religion, sex, sexual orientation, national origin, citizenship, disability, military leave or veteran status, genetic information, or any other status protected by applicable federal, state or local law. SERS is committed to ensuring all applicants can successfully submit an application for consideration. If you have a disability, and you wish to discuss potential accommodations to complete your application for employment, please call (614) 340-2255.
SERS does not accept unsolicited recruiter and agency resumes and will not pay fees to any third-party agency or company that does not have a signed agreement with SERS.
47611.00 To 66655.00 (USD) Annually
