ECS Coordinator II

State of Oklahoma•Oklahoma City, OK

1d•Onsite

About The Position

The Eligibility and Coverage Services Coordinator II / IO Program Coordinator II plays a critical role in supporting the Oklahoma Health Care Authority's mission by ensuring efficient and effective administration of SoonerCare and other Medicaid programs. This position is responsible for resolving member and provider inquiries, processing claims, managing member enrollments, and maintaining compliance with program policies. The role requires strong communication skills, attention to detail, and the ability to navigate complex program guidelines, all while maintaining a high standard of service to internal and external stakeholders.

Requirements

1 year of experience in clerical office work or as a customer services representative plus 2 years of experience in customer service, processing tax returns, bookkeeping or closely related work OR An equivalent combination of education and experience, substituting thirty semester hours of college, including six semester hours in business or public administration for the required experience plus 2 years of experience in customer service, processing tax returns, bookkeeping or closely related work.
Resume/CV with complete work and education history.

Nice To Haves

Certifications in any of the following areas: Certified Medicaid Professional (CMP), Customer Service or Call Center Management Certification, Project Management Certification (PMP), Lean Six Sigma Certification, Certified Health Data Analyst (CHDA), or Health Insurance Portability and Accountability Act (HIPAA) Certification

Responsibilities

Research and resolve provider and member inquiries, complaints, and denied claims.
Investigate and address access to care issues, fraud, abuse, and quality assurance complaints.
Interpret and communicate SoonerCare policies and procedures to providers, members, and stakeholders.
Educate on program coverage, services, and eligibility guidelines for SoonerCare, BCC, DOC Inpatient, TEFRA, and Insure OK programs.
Process and resolve electronic claims inquiries and claims reconciliation.
Manage member applications, enrollments, plan changes, and eligibility verifications.
Identify and report system discrepancies.
Research and implement system updates and corrections.
Stay current on SoonerCare rule revisions and program changes.
Maintain organized reference materials and update written controls.
Coordinate with other departments on referral issues and operational procedures.
Communicate independently with members and stakeholders to resolve issues.
Participate in special projects, member outreach, and educational efforts.
Represent OHCA in meetings, seminars, and training forums.
Support workflow during staff absences and manage high call volumes.
Other duties as assigned.