Medical Operations Program Assistant II

the South Dakota State Government•Pierre, SD

1d•Onsite

About The Position

The Division of Medical Services is seeking an Operations Program Assistant II to support the South Dakota Medicaid Program. The position provides customer service to Medicaid providers and serves as a key resource in the day-to-day operations of the Medicaid Data Entry team. The role evaluates requests to reprocess claims and approves or denies provider claim reconsideration requests submitted through the Medicaid Online Portal. It monitors and responds to provider-portal and DSS email inquiries, supports training on entering claims into the Portal, and directs advanced inquiries to appropriate personnel as needed. The position also compiles and reports data-entry errors and communicates recurring issues to the Operations Manager and CAPS Supervisor to support staff training. Additional work includes monitoring daily claims and workflow to support timely processing, assisting with complex claims, and providing other support to the claims-processing and data-entry teams as assigned. The position is full-time, 40 hours per week, and is located in Pierre or Sioux Falls, South Dakota. Applicants must apply online and attach a resume. A National Career Readiness Certificate may be submitted if possessed, but it is not required.

Requirements

Experience in data entry, claims processing, or customer service.
Ability to use written words and skillful verbal communication.
Ability to interpret and apply policies accurately to determine appropriate outcomes of claim reconsiderations.
Ability to establish, build, and maintain cooperative and productive internal and external relationships.
Ability to 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 to changing policies and procedures.
Ability to manage multiple tasks while maintaining accuracy and meeting deadlines.
Ability to navigate provider portals, email systems, and data-management tools.
Ability to work independently and support team members.
Applicants must attach a resume and apply online; emailed resumes or submissions are not accepted.
Hired applicants must verify identity and eligibility to work in the United States and complete Form I-9. The State uses E-Verify and does not sponsor work visas for new or existing employees.

Nice To Haves

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

Responsibilities

Provide high-quality customer service to South Dakota Medicaid providers.
Serve as a key resource in 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 the claims-processing and data-entry teams as assigned.