Medical Operations Program Assistant II

State of South Dakota•Sioux Falls, SD

2d•Onsite

About The Position

The Division of Medical Services is seeking a highly motivated individual to support day-to-day operations of the South Dakota Medicaid Data Entry team and provide high-quality customer service to South Dakota Medicaid providers. The role reviews requests to reprocess claims and approves or denies provider claim reconsideration requests submitted through the Medicaid Online Portal. The position monitors and responds to inquiries received through the provider portal and the DSS email system, supports training on claim entry into the Portal, and directs advanced inquiries to the appropriate personnel as needed. It compiles and reports data-entry errors and communicates recurring issues to the Operations Manager and CAPS Supervisor to support staff training. The role also monitors daily claims and workflow to help ensure timely processing, assists with complex claims, and provides other support to claims-processing and data-entry teams as needed. The position is based in Pierre or Sioux Falls, South Dakota, and is full-time at 40 hours per week. Applicants must apply online and attach a resume. A National Career Readiness Certificate may be submitted if held, but it is not required. The State of South Dakota does not sponsor work visas. Employees must verify identity and eligibility to work in the United States and complete Form I-9; the state uses E-Verify upon hire.

Requirements

Experience in data entry, claims processing, or customer service.
Ability to use written words and communicate verbally skillfully.
Ability to accurately interpret and apply policies to determine appropriate outcomes of claim reconsiderations.
Ability to establish, build, and maintain cooperative and productive internal and external relationships.
Demonstrate compassion, respect, courtesy, and tact in interactions.
Ability to gather and analyze data to identify problems and potential issues, and develop and implement appropriate resolutions.
Ability to communicate clearly and concisely, verbally and in writing, while keeping appropriate parties informed.
Ability to adapt effectively to changing policies and procedures.
Ability to manage multiple tasks simultaneously while maintaining accuracy and meeting deadlines.
Confidence navigating provider portals, email systems, and data-management tools.
Ability to work independently and provide support to team members.
Must attach a resume and apply online; emailed resumes or submissions will not be accepted.
Must verify identity and eligibility to work in the United States and complete Form I-9 upon hire.

Nice To Haves

Experience with Medicaid, healthcare billing, or medical claims is preferred but not necessary.
A National Career Readiness Certificate may be submitted with the application but is not required.

Responsibilities

Provide high-quality customer service to South Dakota Medicaid providers.
Support the day-to-day operations of the Medicaid Data Entry team.
Determine whether requests to reprocess claims are appropriate.
Approve or deny provider claim reconsideration requests submitted through the Medicaid Online Portal.
Monitor and respond to inquiries received through the provider portal and DSS email system.
Support training on claim entry into the Portal.
Direct advanced inquiries to appropriate personnel as needed.
Compile and report data-entry errors and communicate recurring issues to the Operations Manager and CAPS Supervisor to support staff training.
Monitor daily claims received and workflow to help ensure timely processing.
Assist with processing complex claims.
Provide other support to claims-processing and data-entry teams as needed.