Billing & Claims Support Specialist (Medical Assistance Consultant II)

State of Illinois•Springfield, IL

1d•$5,384 - $7,631•Onsite

About The Position

The Department of Healthcare and Family Services, Medical Programs/Bureau of Professional and Ancillary Services is seeking to hire a motivated candidate to serve as Prior Approval Specialist. Under the direction of the Prior Approval and Customer Relations/Special Case Programs managers, this position conducts professional work in the interpretation of Department policies, procedures, instructions, in the prior approval process for durable medical equipment and specialized medical services. This position will provide a current status of prior, approval requests within the MMIS database to providers of these services. The ideal candidate will possess strong communication skills, confidence, the ability to thrive in high volume and fast paced environment, and problem-solving skills to ensure operations are running effectively. HFS values employees with different backgrounds, life experiences, and talents. At the Illinois Department of Healthcare and Family Services (HFS), we value staff as our greatest asset. We work in a spirit of teamwork to help millions of Illinoisans access high quality healthcare and fulfill child support obligations to advance their physical, mental, and financial well-being. We provide healthcare coverage for children and adults through Medicaid and other medical programs, and we help ensure that children receive financial resources from both their parents through Child Support Services. The HFS Office of the Inspector General investigates, audits and reviews program activity to ensure the integrity of our programs is maintained. HFS is committed to promoting and preserving a workplace culture that embraces diversity, equity, and inclusion. We welcome and value employees with different backgrounds, life experiences, and talents. It is the collective sum of our individual differences that provides a broad perspective, leading to greater innovation and achievement. In recruiting for our team, we recognize the unique contributions of each applicant regardless of culture, ethnicity, race, national origin, sex, gender identity and expression, age, religion, disability, and sexual orientation. HFS is an equal opportunity employer.

Requirements

Requires knowledge, skill, and mental development equivalent to completion of four (4) years of college with courses in medical social work
Requires two (2) years professional experience in fields related to medical social work
Requires completion of a background check and self-disclosure of criminal history
Requires the ability to utilize and maintain state issued equipment such as a laptop
The conditions of employment listed her are incorporated and related to any of the job duties as listed in the job description

Nice To Haves

Licensure in one of the following specialties: Registered Nurse, Speech-Language Pathologist, Respiratory Therapist, Physical Therapist, or Occupational Therapist
Three (3) years of experience working with medical terminology
One (1) year of experience working with federal, state and local legislation and agency requirements pertinent to public assistance, medical care and rehabilitation assistance
One (1) year of experience providing consultation and instruction related to professional and medical social casework
One (1) year of experience providing customer service to medical provider offices on behalf of a payer
One (1) year of experience addressing policies and procedural inquiries from providers, interest groups and the general public

Responsibilities

Under direction, serves as a Prior Approval Specialist and conducts professional work in the interpretation of Department policies, procedures, instructions, and other related aspects regarding the Prior Approval process for durable medical equipment and specialized medical services
Responds to telephone and/or written correspondence to/from medical vendors, agency staff, and the general public regarding inquiries, complaints, and requests for information and assistance
Researches and analyzes prior approval requests submitted by medical providers to determine action for entering prior approvals
Stays up to date on policy and procedure changes
Attends meetings
Performs other duties as required or assigned which are reasonably within the scope of the duties enumerated above

Benefits

Monday-Friday work schedule
Flexible work schedules are available in many program areas. (Remote work may be an option for certain positions.)
Health, Life, Vision, and Dental Insurance
Pension Plan
Paid Parental Leave
Deferred Compensation Program and other pre-tax benefit programs (Medical/Daycare)
Employees earn (12) paid Sick Days annually.
New Employees earn (10) paid Vacation Days their first year of service and can earn up to (25) paid Vacation Days annually.
Employees earn (3) paid Personal Days annually.
(13-14) paid holidays annually (based on start date)