ECS Coordinator III

State of Oklahoma • Oklahoma City, OK

1d • $25 • Onsite

About The Position

This position serves as a key resource for coordinating daily member service activities, ensuring efficient workflow, and acting on behalf of management when needed. This role provides comprehensive training, resolves complex inquiries and complaints, interprets and communicates SoonerCare policies and procedures, and identifies operational improvements. The specialist supports member enrollment, claims adjudication, and system problem resolution while ensuring compliance with Medicaid regulations and OHCA policies. Through advanced problem-solving, relationship management, and customer service skills, the specialist enhances service delivery to members and stakeholders across the agency.

Requirements

• In-depth knowledge of Medicaid policies, federal and state regulations, and program administration principles.
• Strong skills in communication, problem-solving, and relationship management.
• 1 year of experience in clerical office work or as a customer services representative plus 3 years of experience in customer service, processing tax returns, bookkeeping or closely related work OR An equivalent combination of education and experience, substituting 30 semester hours of college, including 6 semester hours in business or public administration for the required experience plus 3 years of experience in customer service, processing tax returns, bookkeeping or closely related work.
• Application must include a resume/CV with complete work and education history.

Nice To Haves

• Certifications in any of the following areas: Certified Medicaid Professional (CMP), Project Management Professional (PMP) or Certified Associate in Project Management (CAPM), Certified Provider Credentialing Specialist (CPCS), Certified Customer Service Professional (CCSP)
• Experience or certification in Lean Six Sigma or Process Improvement
• Certifications in Health Information Technology (HIT) or Electronic Health Records (EHR)

Responsibilities

• Serves as team leader in planning and coordinating daily member services activities, acting on behalf of or in the absence of managers.
• Acts as a supervisor and assists in maintaining workflow during staff absences.
• Provides comprehensive training to staff, contractors, agency partners, and stakeholders on SoonerCare policies and procedures.
• Develops and implements training materials and represents OHCA in seminars, training forums, and conferences.
• Answers complex incoming telephone and written inquiries from members, vendors, and other stakeholders, requiring individual research and interpretation of federal and agency rules.
• Independently analyzes, investigates, and resolves complex inquiries and complaints from members in a timely manner.
• Assists with the development, interpretation, and communication of written policies and materials related to member inquiries.
• Keeps abreast of OHCA/SoonerCare policies and provides accurate interpretation to providers and members.
• Identifies potential operational and contractual issues, communicates, and resolves issues with members and participates in the formulation of procedures to resolve conflicts.
• Coordinates with appropriate departments to resolve system problems and develop timely solutions.
• Determines eligibility, verifies, and enters data, and resolves issues related to enrollment and premium payments.
• Processes enrollment, plan changes, and corrections to member enrollment data systems.
• Facilitates claims adjudication, capitation, and reconciliation, and processes electronic claims inquiries.
• Participates in the OHCA member call center, answering a wide variety of questions and resolving problems related to contract requirements, licensing, and electronic funds transfer.
• Provides member training and keeps updated on OHCA/SoonerCare policies to provide accurate information to stakeholders.
• Assists division leadership with special projects and the development of training materials.
• Monitors incoming calls, staffing availability, and call wait times, ensuring agents understand and comply with performance standards and policies.
• Identifies complex problem areas within MMIS and the telephone response system, making recommendations for overall improvements.
• Other duties as assigned.

Benefits

• Generous state-paid benefit allowance to offset insurance premiums.
• A wide selection of insurance plans with no pre-existing condition exclusions.
• Flexible Spending Accounts for health care and dependent care.
• Retirement Savings Plan with employer contributions.
• 11 paid holidays annually.
• 15 days of vacation and 15 days of sick leave in the first year.
• Longevity Bonus recognizing years of public service.
• Public Service Loan Forgiveness eligibility and tuition reimbursement.
• Wellness benefits, including an on-site gym and fitness center discounts.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: No Education Listed