Reference #: 4667932
THE POSITION
Are you looking for an amazing opportunity to utilize your technological aptitude? The Office of Developmental Programs (ODP), Bureau of Financial Management and Program Support is seeking a detail-oriented individual who has a passion for investigative, research, and analytical work. Consider joining our expert team as a claims resolution specialist and advance your professional talents!DESCRIPTION OF WORK
In this role, you will serve as a claims resolution specialist offering customer service to provider inquiries on the ODP's Claims Resolution Hotline and Claims Resolution Resource Account. You will research and prepare recommendations for the resolution of complications and concerns identified through the PROMISe claims processing system or interfaces with the PROMISe system to result in successful claim payment. Due to the nature of this work, you will be required to maintain a working knowledge of ODP data systems. You will also engage in system monitoring activities such as the Electronic Visit Verification (EVV) manual compliance, account recovery audits, edit and audit exemptions, as well as review of suspended claims for payment. In addition, you will exam and analyze policy to ensure that the procedure codes, diagnosis records, edit, audits, and resolutions used by ODP follow all regulations and policies.Interested in learning more? Additional details regarding this position can be found in theposition description.Work Schedule and Additional Information:
Full-time employment (37.50-hour work week)
Work hours are 8:00 AM to 4:00 PM, Monday - Friday, with a 30-minute lunch.
Telework: You may have the opportunity to work from home (telework) part-time for the initial training period with possible full-time telework. You will be required to report to the office 1 day per month. In order to telework, you must have a securely configured high-speed internet connection and work from an approved location inside Pennsylvania. If you are unable to telework, you will have the option to report to the headquarters office in Harrisburg.
There is regular travel throughout the commonwealth for meetings and trainings as determined by operational needs after completion of the training period.Salary:In some cases, the starting salary may be non-negotiable.
You will receive further communication regarding this position via email. Check your email, including spam/junk folders, for these notices.
REQUIRED EXPERIENCE, TRAINING & ELIGIBILITY
QUALIFICATIONS
Minimum Experience and Training Requirement:One year of professional experience developing, implementing, or evaluating human services, social services, health care services, or health care insurance programs.Other Requirements:
You must meet thePA residency requirement. For more information on ways to meet PA residency requirements, follow the linkand click on Residency.
You must be able to perform essential job functions.How to Apply:
Resumes, cover letters, and similar documents will not be reviewed, and the information contained therein will not be considered for the purposes of determining your eligibility for the position. Information to support your eligibility for the position must be provided on the application (i.e., relevant, detailed experience/education).
Your application must be submitted by the posting closing date. Late applications and other required materials will not be accepted.
Failure to comply with the above application requirements may eliminate you from consideration for this position.Veterans:Pennsylvania law (51 Pa. C.S. 7103) provides employment preference for qualified veterans for appointment to many state and local government jobs. To learn more about employment preferences for veterans, go to www.employment.pa.gov/Additional%20Info/Pages/default.aspx and click the Veterans' Preference tab or contact us at ra-cs-vetpreference@pa.gov.Telecommunications Relay Service (TRS):711 (hearing and speech disabilities or other individuals).If you are contacted for an interview and need accommodations due to a disability, please discuss your request for accommodations with the interviewer in advance of your interview date.EXAMINATION INFORMATIONCompleting the application, including all supplemental questions, serves as your exam for this position. No additional exam is required at a test center (also referred to as a written exam).
Your score is based on the detailed information you provide on your application and in response to the supplemental questions.
Your score is valid for this specific posting only.
You must provide complete and accurate information or:
your score may be lower than deserved.
you may be disqualified.
You may only apply/test once for this posting.
Your results will be provided via email.The Commonwealth is an equal employment opportunity employer and is committed to a diverse workforce. The Commonwealth values inclusion as we seek to recruit, develop, and retain the most qualified people to serve the citizens of Pennsylvania. The Commonwealth does not discriminate on the basis of race, color, religious creed, ancestry, union membership, age, gender, sexual orientation, gender identity or expression, national origin, AIDS or HIV status, disability, or any other categories protected by applicable federal or state law. All diverse candidates are encouraged to apply.
