Accountant/Examiner 3 (PN 20014051)
About The Position
The Complex Medical Help (CMH) program is seeking a detail-oriented professional to support healthcare program operations by analyzing claims, ensuring compliance and improving processes that impact clients and providers. Duties include: Review and audit daily financial and claims transactions for accuracy and compliance. Authorize payments and ensure propers coding within applicable systems. Analyze claimant data, billing, and expenses to ensure completeness and eligibility. Monitor pharmacy benefit operations and ensure compliance with state and federal regulations. Administer pharmacy benefits, including eligibility and co-pay determinations. Investigate claims and rejections and recommend process improvements. Review payment records, claims data, and third-party reports to resolve issues and support stakeholders. Prepare reports, summaries, and analyses to support decision-making. Conduct research and develop written materials on program policies and system updates. Collaborate with internal teams to identify and recover funds efficiently. Support case conferences by providing data, analysis, and system insights. Perform system and eligibility analysis related to third-party payers.
Requirements
- Completion of undergraduate core coursework in accounting or 2 yrs. exp. in accounting.
- Completion of undergraduate core coursework in business administration, economics, computer science or related field AND 16 semester or 24 quarter hours in accounting.
- 12 mos. exp. as Accountant/ Examiner 2, 66112 with state government exp. commensurate with duties to be assigned.
- Equivalent of Minimum Class Qualifications for Employment noted above.
- Accounting and Finance
- Auditing
- Claims Examination
- Compliance Enforcement
- Analyzation
- Attention to Detail
- Interpreting Data
Nice To Haves
- Bachelors or advanced degree in accounting, business administration, economics, computer science or related field
- Experience in pharmacy operations (e.g., prescription fulfillment, claims resolution)
- Experience working with third-party payers and coordinating benefits
- Experience working with spreadsheet software (e.g., Excel, Google Sheets)
- Experience working with medical billers/providers, case managers, and/or clients to resolve pharmacy claims billing issues.
- Experience with Accounts Payable/Receivable
Responsibilities
- Review and audit daily financial and claims transactions for accuracy and compliance.
- Authorize payments and ensure propers coding within applicable systems.
- Analyze claimant data, billing, and expenses to ensure completeness and eligibility.
- Monitor pharmacy benefit operations and ensure compliance with state and federal regulations.
- Administer pharmacy benefits, including eligibility and co-pay determinations.
- Investigate claims and rejections and recommend process improvements.
- Review payment records, claims data, and third-party reports to resolve issues and support stakeholders.
- Prepare reports, summaries, and analyses to support decision-making.
- Conduct research and develop written materials on program policies and system updates.
- Collaborate with internal teams to identify and recover funds efficiently.
- Support case conferences by providing data, analysis, and system insights.
- Perform system and eligibility analysis related to third-party payers.
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Number of Employees
5,001-10,000 employees
