Job Posting Title

Agency

Supervisory Organization

Job Posting End Date

Refer to the date listed at the top of this posting if available. Continuous if date is blank.

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

Job Type

Compensation

Why Youll Love Working Here

At the Oklahoma Health Care Authority (OHCA) your work matters. Every day our team helps ensure Oklahomans have access to better health and better care. Guided by our core values Passion for Purpose Trust & Transparency Empowerment & Accountability Best-in-Class Outcome-Driven and Servant Leadership we foster a workplace where people feel supported respected and empowered to make an impact. Learn more about OHCA.

Lets Talk Benefits

We know your great work deserves great support. Heres a snapshot of what we offer for all eligible employees.

• Generous state-paid benefit allowance to offset insurance premiums.

• A wide selection of insurance plans with no pre-existing condition exclusions.

• Flexible Spending Accounts for health care and dependent care.

• Retirement Savings Plan with employer contributions.

• 11 paid holidays annually.

• 15 days of vacation and 15 days of sick leave in the first year.

• Longevity Bonus recognizing years of public service.

• Public Service Loan Forgiveness eligibility and tuition reimbursement.

• Wellness benefits including an on-site gym and fitness center discounts.

Job Description

Location: 4345 N Lincoln Blvd Oklahoma City OK 73105

Salary: 47463.00

Work Schedule: Monday Friday

Primary Hours: 8:00 a.m. 5:00 p.m.

Agency/Division Information

The Oklahoma Health Care Authority (OHCA) works to ensure Oklahomans have access to better health and better care. The agencys core values include passion for purpose trust and transparency empowerment and accountability best in class and outcome-driven and servant leadership. As part of the interview process candidates may be required to attend an in-person interview at our Oklahoma City office.

Position Purpose

The Eligibility and Coverage Services Coordinator II plays a critical role in supporting the Oklahoma Health Care Authoritys mission by ensuring efficient and effective administration of SoonerCare and other Medicaid programs. This position is responsible for resolving member and provider inquiries processing claims managing member enrollments and maintaining compliance with program policies. The role requires strong communication skills attention to detail and the ability to navigate complex program guidelines all while maintaining a high standard of service to internal and external stakeholders.

Principle Activities May Include:

• Research and resolve provider and member inquiries complaints and denied claims.

• Investigate and address access to care issues fraud abuse and quality assurance complaints.

• Interpret and communicate SoonerCare policies and procedures to providers members and stakeholders.

• Educate on program coverage services and eligibility guidelines for SoonerCare BCC DOC Inpatient TEFRA and Insure OK programs.

• Process and resolve electronic claims inquiries and claims reconciliation.

• Manage member applications enrollments plan changes and eligibility verifications.

• Identify and report system discrepancies.

• Research and implement system updates and corrections.

• Stay current on SoonerCare rule revisions and program changes.

• Maintain organized reference materials and update written controls.

• Coordinate with other departments on referral issues and operational procedures.

• Communicate independently with members and stakeholders to resolve issues.

• Participate in special projects member outreach and educational efforts.

• Represent OHCA in meetings seminars and training forums.

• Support workflow during staff absences and manage high call volumes.

• Other duties as assigned.

Knowledge Skills Abilities and Competencies

The Eligibility and Coverage Services Coordinator II requires in-depth knowledge of Medicaid program policies strong communication skills for resolving inquiries and the ability to manage complex administrative processes. This role demands attention to detail effective collaboration and the ability to navigate both member and provider concerns. The Korn Ferry competencies that align well with this position are Manages Complexity for handling detailed program and policy administration and Collaborates for working effectively with both internal and external stakeholders to resolve issues and ensure program success.

**To be considered for this position your application must include a resume/CV with complete work and education history.**

Education and Experience

• 1 year of experience in clerical office work or as a customer services representative plus 2 years of experience in customer service processing tax returns bookkeeping or closely related work. OR

• An equivalent combination of education and experience substituting thirty semester hours of college including six semester hours in business or public administration for the required experience plus 2 years of experience in customer service processing tax returns bookkeeping or closely related work.

Preference may be given to candidates with:

• Certifications in any of the following areas: Certified Medicaid Professional (CMP) Customer Service or Call Center Management Certification Project Management Certification (PMP) Lean Six Sigma Certification Certified Health Data Analyst (CHDA) or Health Insurance Portability and Accountability Act (HIPAA) Certification

Physical Demands and Work Environment

Work is typically performed in an office setting with climate-controlled settings and exposure to moderate noise the course of performing job duties employees are required to speak stand walk and reach with their hands and arms. This position requires extended periods of sitting and daily use of computers and phones. Employees must be willing to complete all job-related travel associated with this position. Being present at the office is an essential function of the job.

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 .

Notice to applicants:

Please add 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 .

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 internally through WorkdayJobs Hub.

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 active State of Oklahoma employees must apply for open positions internally through the Workday Jobs Hub.

If you are needing any extra assistance or have any questions relating to a job you have applied for please click the link below and find the agency for which you applied for additional information:

Agency Contact