ECS Coordinator III

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 transparencyempowermentand accountability best in class and outcome-driven and servant leadership.As part of the interview process candidates maybe requiredto attend an in-person interview at our Oklahoma City office.

This positionserves as a key resource for coordinating daily member service activities ensuring efficient workflow and acting on behalf of management when needed. This role provides comprehensive training resolves complex inquiries and complaintsinterpretsand communicatesSoonerCarepolicies and procedures andidentifiesoperational improvements. The specialist supports member enrollment claims adjudication and system problem resolution while ensuring compliance with Medicaid regulations and OHCA policies. Through advanced problem-solving relationship management and customer service skills the specialist enhances service delivery to members and stakeholders across the agency.

• Serves as team leader in planning and coordinating daily member services activities acting on behalf of or in the absence of managers.

• Acts as a supervisor andassistsinmaintainingworkflow during staff absences.

• Provides comprehensive training to staff contractors agency partners and stakeholders onSoonerCarepolicies and procedures.

• Develops and implements training materials andrepresentsOHCA in seminars training forums and conferences.

• Answers complex incoming telephone and written inquiries from members vendors and other stakeholders requiring individual research and interpretation of federal and agency rules.

• Independently analyzes investigates and resolves complex inquiries and complaints from membersin a timely manner.

• Assistswith the development interpretation and communication of written policies andmaterials related to member inquiries.

• Keeps abreast of OHCA/SoonerCarepolicies and providesaccurateinterpretation to providers and members.

• Identifiespotential operational and contractual issues communicates and resolves issues with members andparticipatesin the formulation of procedures to resolve conflicts.

• Coordinates withappropriate departmentsto resolve system problems and developtimelysolutions.

• Determineseligibility verifies and enters data and resolves issues related to enrollment and premium payments.

• Processes enrollment plan changes and corrections to member enrollment data systems.

• Facilitates claims adjudication capitation and reconciliation and processes electronic claims inquiries.

• Participates in the OHCA member call center answering a wide variety of questions and resolving problems related to contract requirements licensing and electronic funds transfer.

• Provides member training and keeps updated on OHCA/SoonerCarepolicies to provideaccurateinformation tostakeholders.

• Assistsdivision leadership with special projects and the development of training materials.

• Monitors incoming calls staffing availability and call wait times ensuring agents understand andcomply withperformance standards and policies.

• Identifiescomplex problem areas within MMIS and the telephone response system making recommendations for overall improvements.

• Other duties as assigned.