Location: Saint Paul,MN, USA
**Working Title: Provider Resource Center Representative**
**Job Class: Minnesota Health Insurance Programs Representative 1**
**Agency: Human Services Dept**
+ **Job ID** : 80657
+ **Location** : St. Paul
+ **Telework Eligible** : Yes
+ **Full/Part Time** : Full-Time
+ **Regular/Temporary** : Unlimited
+ **Who May Apply** : Open to all qualified job seekers
+ **Date Posted** : 11/26/2024
+ **Closing Date** : 12/02/2024
+ **Hiring Agency/Seniority Unit** : Human Services Dept / DHS Central Office AFSCME
+ **Division/Unit** : Health Care Administration / Medicaid Payment and Provider Services
+ **Work Shift/Work Hours** : Day Shift
+ **Days of Work** : Monday - Friday
+ **Travel Required** : No
+ **Salary Range:** $23.26 - $32.79 / hourly; $48,566 - $68,465 / annually
+ **Classified Status** : Classified
+ **Bargaining Unit/Union** : 207 - Technical/AFSCME
+ **Work Area** : G - Member and Provider Services
+ **FLSA Status** : Nonexempt
+ **Re-Posting** : Yes
+ Designated in Connect 700 Program for Applicants with Disabilities ( : Yes
The Department of Human Services is unable to provide sponsorship for work visas. Applicants must be eligible to work in the United States at the start of employment. DHS does not participate in E-Verify.
**The work you'll do is more than just a job.**
At the State of Minnesota, employees play a critical role in developing policies, providing essential services, and working to improve the well-being and quality of life for all Minnesotans. The State of Minnesota is committed to equity and inclusion, and invests in employees by providing benefits, support resources, and training and development opportunities.
****This position was previously announced on 10/02/2024. If you already applied for this job, you do not need to reapply.** **
*****This posting may be used to fill multiple openings*****
As a MN Health Insurance Rep 1 you will work in a heavy volume, customer service-oriented work environment, expeditiously triaging and responding to caller needs in accordance with set standards and call management practices. You will balance the need to service a continuous flow of customer calls with the importance of conducting thorough research, providing quality services and excellent customer service, and ensuring relevant, accurate information.
This position requires the incumbent to answer approximately 80-120 calls per day from health care providers. The incumbent identify and respond to caller needs, within given parameters. Provide referrals to other locations within DHS, counties, and other state agencies, only if needed to obtain specialized or specific types of information/services.
Responsibilities include:
Investigate and resolve and/or facilitate resolution of simple to highly complex problems reported by health care providers, members or other entities relating to MNsure, MHCP and managed care plans.
Navigate through various systems to obtain needed recipient and provider information; track transactions through historical claims data to isolate the problem/error and determine needed corrections and/or actions.
Develop and maintain ongoing working relationships with member and provider Groups, their billing practices, recipient populations, medical services/ procedures, pharmaceuticals, and claims processing cycles.
Instruct callers on, procedures, forms, and eligibility in association with MMIS and MN-ITS systems.
**Minimum Qualifications**
+ Two years of customer service experience.
+ One year of experience in a high volume, deadline driven and accuracy-focused call center environment answering phone calls and meeting performance and production standards
+ Must be able to administer policies, procedures, and systems used to make eligibility determinations.
+ Must be able to navigate multiple software applications, databases, as well as possessing data entry skills.
+ Strong math skills using multiple sources of documentation.
+ Strong oral and written communication skills.
+ Must be able to read, speak and write English well enough to understand, apply and explain complex eligibility policies.
+ Quickly adapt to changing policies and procedures.
+ Strong multi-tasking skills
+ Must be able to work independently with a strong work ethic and demonstrated record of regular attendance.
**Preferred Qualifications**
+ Experience with the Medical Management Information System (MMIS) payment and eligibility system.
+ Experience with health care billing.
+ Experience with electronic data interchange (EDI).
+ Experience working in a health care call center.
+ Experience with Minnesota Health Care Programs (MHCP) claims.
+ Familiarity with medical terminology.
+ Variety of experiences working effectively with others from different backgrounds and cultures.
**Additional Requirements**
To facilitate proper crediting, please ensure that your resume clearly describes your experience in the areas listed and indicates the beginning and ending month and year for each job held.
REFERENCE/BACKGROUND CHECKS - The Department of Human Services will conduct reference checks to verify job-related credentials and criminal background check prior to appointment.
AN EQUAL OPPORTUNITY EMPLOYER
Minnesota State Colleges and Universities is an Equal Opportunity employer/educator committed to the principles of diversity. We prohibit discrimination against qualified individuals based on their race, sex, color, creed, religion, age, national origin, disability, protected veteran status, marital status, status with regard to public assistance, sexual orientation, gender identity, gender expression, or membership in a local commission as defined by law. As an affirmative action employer, we actively seek and encourage applications from women, minorities, persons with disabilities, and individuals with protected veteran status.
Reasonable accommodations will be made to all qualified applicants with disabilities. If you are an individual with a disability who needs assistance or cannot access the online job application system, please contact the job information line at 651-###-#### or email ...@state.mn.us . Please indicate what assistance is needed.