Job description
Job Posting Title
Financial Analyst II
Agency
807 HEALTH CARE AUTHORITY
Supervisory Organization
Finance
Job Posting End Date (Continuous if Blank)
March 30, 2023
Note: Applications will be accepted until 11:59 PM on the day prior to the posting end date above.
Estimated Appointment End Date (Continuous if Blank)
Full/Part-Time
Full time
Job Type
Regular
Compensation
47,463.00 / annual
Job Description
Basic Purpose
Under general supervision, performs technical work involving review and analysis related to the adjudication of various medical claims and adjustments, or recovery of third party or other funds. Incumbents in this class perform at the full performance level, technical work involved in investigating claim and recovery documents and records of medical recipients and providers to adjudicate medical claims, adjustments, or fund recoveries. They may provide recommendations to higher-level analysts in completing analysis or research concerning the resolution of a non-routine, specialized finance issue. There are no supervisory responsibilities assigned at this level, but training and assistance may be provided to lower level technical staff as required. Incumbents are assigned a caseload that must be completed within prescribed timeframes, which requires organizing and coordinating duties to perform most effectively. They must perform job duties susceptible to different methods of solution and require flexibility in interpreting the appropriate method to complete the assignment. A variety of factors must be weighed and considered before a final decision can be reached. Incumbents must develop a highly specialized knowledge of a specific area as it relates to the interpretation of state and federal agency policies, procedures, regulations and laws.
Typical Functions
- Analyzes researches and/or investigates technically difficult claims, adjustments and fund recoveries related to the delivery of Medicaid or other health services. Initiates action to correct erroneous payments, recover third party liability or other funds, or make final disposition of a claim for payment.
- Analyzes researches and/or investigates correspondence related to complex voluntary refunds received from Medicaid or other health providers. Initiates action to correct provider history or payment. Refers to lead worker any discrepancy in refunded amount.
- Analyzes researches and/or investigates TPL related reports from the MMIS. Initiates action to correct provider history or payment.
- Researches and verifies insurance coverage of current members
- Resolves discrepancies that occur on paid claims, credits, adjustments and recoveries of funds.
- Attends meetings with agency personnel and other officials.
- Initiates contact with claimants, third party administrators, clients or other agents to solicit information, correct errors or omissions on claim forms, and to investigate questionable data.
- Under direction, initiates action to process recoupment of funds from a Medicaid or other health provider.
- Assists with the monitoring and tracking of unit based productivity measures through data entry or other routine tasks.
- Maintains control of transactions initiated which interface with the fiscal agent’s computer system. Monitors accuracy of processing and ensures transactions are completed in accordance with agency policy and state and federal guidelines.
- Make recommendations and assist in the decision making process of all MMIS sub-systems.
- Prepares and files legal documents for the recovery of funds from third party payers, including liens on estates, probates and income pensions and workers compensation documentation.
- Approves or denies claims as appropriate after review and analysis of all information obtained.
- Arranges for reimbursement to the agency payments made on behalf of a client, which were made erroneously or which should have been paid by a third party payor; e.g., Worker’s Compensation, health insurance, casualty insurance, Medicare, etc.
- Identifies and reports system discrepancies to lead worker.
- Responds to oral and written inquiries and answers phone calls from medical providers, HMOs, recipients, court and county clerks, attorneys and third party administrators on medical related issues. Assists in training providers and others on Finance issues, especially remittance advice statements, submission of claims and the recoupment process.
- Other duties may be assigned.
Education and Experience
- Associate’s degree AND
- 18 months of technical administrative or fiscal related work OR
- An equivalent combination of education and experience totaling 3 ½ years.
Preference May Be Given to Candidates With:
- SoonerCare experience
- Cost reporting experience
- ICE experience, specifically Provider and Financial subsystems
- Clerical experience in a professional setting
- Bilingual fluency
- Experience with MS Office; specifically Word (Mail Merge), Excel and Access
- Experience with Business Objects
Special Requirements
Physical Demands:
- Must be able to remain sitting for prolonged periods at a desk and working on a computer.
- Must be able to move or lift up to 15 pounds at various times.
Work Environment:
- The office work environment includes regular exposure to general office equipment such as computer equipment, phones, and copy machines.
Accommodation Statement:
The Oklahoma Health Care Authority complies with applicable State and Federal civil rights laws and does not discriminate. All qualified applicants will receive consideration for employment without regard to race, color, sex, religion, disability, age, national origin, or genetic information. If a reasonable accommodation is needed to participate in the job application or interview process, to perform essential job functions, and/or to receive other benefits and privileges of employment, please contact the Civil Rights Coordinator at 405-522-7335.
Notice to applicants:
Please add
personnel@okhca.org
to the address book or “safe-senders” list in your email. All correspondence will come from this address. Be sure to check your junk folder. If you have questions about the status of your application, you can contact the HR team at 405-522-7093.
Note: Applications will be accepted until 11:59 PM on the day prior to the posting end date above.
Current State of Oklahoma employees: must apply for open positions through their Workday account. To apply internally, Go to Careers App located on Workday home screen> Click on “Find Jobs-Internal State of Oklahoma”.
**A complete job application includes: Resume/CV attached with a complete work history and education.**
Equal Opportunity Employment
The State of Oklahoma is an equal opportunity employer and does not discriminate on the basis of genetic information, race, religion, color, sex, age, national origin, or disability.
Current State of Oklahoma employees must apply for open positions through their Workday account. Go to Careers app on WD home screen>Click on 'Find Jobs-Internal State of Oklahoma'.
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