Error Resolution Section Manager (SPSA)

State of Illinois • Springfield, IL

3d • $10,500 - $12,500 • Onsite

About The Position

The Department of Healthcare and Family Services (HFS) is seeking a highly motivated and qualified individual to serve as the Error Resolution Section Manager within the Bureau of Claims Processing. This role is crucial for maintaining the highest operational standards, particularly in processing medical claim documents for timely provider payments, online correction, and utilization review of provider-submitted invoices for proper payment adjudication. The ideal candidate will be dedicated to teamwork, capable of thriving in a fast-paced, evolving environment, possess a strong supervisory background with experience managing large staff, understand the Department's goals and objectives, have experience managing large-scale processing operations, and be committed to promoting quality services on behalf of the State of Illinois. HFS values employees with diverse backgrounds, life experiences, and talents and invites qualified candidates to join the Bureau of Claims Processing team to further the Department's mission.

Requirements

• Requires knowledge, skill, and mental development equivalent to completion of four (4) years of college.
• Requires prior experience equivalent to four (4) years of progressively responsible administrative experience in a public or business organization.

Nice To Haves

• Minimum of four (4) years of experience supervising professional staff in an office setting.
• Minimum of four (4) years of professional experience directing the processing of medical claims and payments for a public or private organization.
• Minimum of three (3) years of professional experience working with on-line claim processing and/or data claim processing.
• Minimum of three (3) years of professional experience developing and implementing program and operational policies and procedures.
• Minimum of three (3) years of professional experience researching and analyzing large sets of claims data.
• Minimum of three (3) years of professional experience communicating with stakeholders at all levels within an organization.
• Minimum of two (2) years of experience working with Microsoft Excel to maintain complex spreadsheets and track daily tasks.
• Licensure in one of the following specialties: Registered Nurse, Licensed Practical Nurse, Speech/Language Pathologist, Respiratory Therapist, Physical Therapist or Occupational Therapist.
• Minimum of one (1) year of experience providing supporting documentation for deposition and/or testimony in a State or Federal court of law.

Responsibilities

• Serves as the Error Resolution Section Manager by planning, developing, and managing the operations of the Error Resolution Section relating to the adjudication and maintenance of medical invoices submitted in accordance with the Medicaid Program, as well as the pricing and prepay processes, special processing of newborn invoices, online-correction processes of Institutional and non-institutional claims with or without attachments, including Medicare crossover claims.
• Serves as a full line supervisor.
• Directs the operation of corrections processing for adjudication of medical invoices through the Department’s Medicaid Management Information System (MMIS), special processing of newborn invoices, processing of electronic claim submissions with and without attachments for all claim types, review and processing preparation of claims with attachments requiring review, including, but not limited to, hysterectomy and sterilization forms, general and post general mode reports, reject and aged document reports, on line correction processing of all hard copy and electronic claims types for institutional and non-institutional invoices with and without attachments, including Medicare Crossover invoices and the Pricing and Prepay utilization review processes.
• Directs the management of the Pricing/Prepay Unit, Special Program Review Unit, On-line Corrections Unit and Medicare unit on the integration of program activities to resolve administrative, policy and procedural issues.
• Consults with management on the integration of program activities.
• Performs other duties as required or assigned which are reasonably within the scope of the duties enumerated above.

Benefits

• Health, Life, Vision, and Dental Insurance
• Pension Plan
• Paid Parental Leave
• Deferred Compensation Program and other pre-tax benefit programs (Medical/Daycare)
• 12 paid Sick Days annually
• 10 paid Vacation Days their first year of service and can earn up to 25 paid Vacation Days annually
• 3 paid Personal Days annually
• 13-14 paid holidays annually (based on start date)

What This Job Offers

• Job Type: Full-time
• Career Level: Manager