Medicaid Services Specialist

State of Delaware • Dover, DE

23h

About The Position

Make a Difference with DHSS Our mission at the Department of Health and Social Services (DHSS) is to improve the quality of life of Delaware citizens by promoting health and well-being, fostering self-sufficiency, and protecting vulnerable populations. We prioritize personal and family independence by assisting individuals and families in a variety of life areas. We offer numerous career opportunities and are dedicated to attracting and retaining highly talented individuals who are ready to make a difference in their community today. DHSS is a great place to kick-start your profession. For more information, please visit https://dhss.delaware.gov/dhss/ today! Summary Statement The incumbent will be responsible for claims adjudication duties and administration of the Hospice Benefit within the division’s Program Integrity Unit. This position adjudicates medical claims and work on excel projects. This task requires to be detailed, follow or create specific procedural instructions, and interpret policy statements carefully. This position will use medical claims and their billing components (Healthcare Common Procedure Coding System, Internal Classification of Diseases HCPCS/ICD-10 coding structures).

Requirements

• Applicants must have education, training and/or experience demonstrating competence in each of the following areas:
• Six months experience in benefits claims processing such as health, dental, or life.
• Six Months experience in using an automated information system to enter, update, modify, delete, retrieve/inquire and report on data.
• Six months experience in interpreting Medicaid laws, rules, regulations, standards, policies and procedures.
• Six months experience in narrative report writing.
• Knowledge of medical terminology.

Responsibilities

• Reviews Medicaid policies and procedures with service providers and explains billing procedures.
• Authorizes approval for reimbursements for new equipment based on review of previous approval for similar equipment, and in accordance with Medicaid guidelines.
• Conducts training to service providers and medical personnel regarding covered equipment, billing and coding procedures.
• Reviews claims submitted by service providers to ensure information is valid and in compliance with regulations.
• Confers with other administrative staff, medical consultants, and community representatives as necessary to resolve policy and payment issues.
• Initiates and develops guidelines/policies for various Medicaid services and recommends program changes.
• Participates with other administrative staff in conducting program analysis and responding to requests for information from providers, government officials and other agencies.
• Revises procedure and coding manuals for use by providers.

What This Job Offers

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