Accountant/Examiner 3 (PN 20014063)

Ohio Department of Administrative Services•Columbus, OH

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 accounting transactions to ensure accuracy and compliance with state and federal regulations. Authorize and process payments for medical claims, billing, and program expenses. Analyze claims data to verify completeness, eligibility, and coordination of benefits. Investigate and resolve denied or rejected claims, identifying root cuases and recommending solutions. Monitor insurance accounts, recievables, and third-party payments to ensure proper processing. Ensure compliance with applicable laws, policies and regulations. Prepare written analyses, summaries and reports to support desicion-making and process improvements. Evaluate claims processing operations and recommend enhancements to imrpvoe efficiency and accuracy. Collaborate with internal teams, providers, and external stakeholders to resolve issues and coordinate services. Respond to inquiries from clients, providers, and third parties regarding claims and payments. Maintain accurate records and documentation, and system updates for claims and authorize activities. Compile and report claim statistics and support monthly billing and reporting processes. Assist in developing procedures and guidelines to improve operational effectiveness.

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 processing health insurance claims (e.g., processing billing, reviewing claims)
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 claims billing issues.
Experience with Accounts Payable/Receivable

Responsibilities

Review and audit accounting transactions to ensure accuracy and compliance with state and federal regulations.
Authorize and process payments for medical claims, billing, and program expenses.
Analyze claims data to verify completeness, eligibility, and coordination of benefits.
Investigate and resolve denied or rejected claims, identifying root cuases and recommending solutions.
Monitor insurance accounts, recievables, and third-party payments to ensure proper processing.
Ensure compliance with applicable laws, policies and regulations.
Prepare written analyses, summaries and reports to support desicion-making and process improvements.
Evaluate claims processing operations and recommend enhancements to imrpvoe efficiency and accuracy.
Collaborate with internal teams, providers, and external stakeholders to resolve issues and coordinate services.
Respond to inquiries from clients, providers, and third parties regarding claims and payments.
Maintain accurate records and documentation, and system updates for claims and authorize activities.
Compile and report claim statistics and support monthly billing and reporting processes.
Assist in developing procedures and guidelines to improve operational effectiveness.