Customer Service Compliance Specialist

Title: Customer Service Compliance Specialist

State Role Title: Health Care Compliance Spec I

Hiring Range: $32.28 - $39.75

Pay Band: 4

Agency: Dept of Med Assistance Svcs

Location: Dept of Medical Asst Services

Agency Website: www.dmas.virginia.gov

Recruitment Type: General Public - G

Job Duties

The Department of Medical Assistance Services (DMAS) is excited to offer a competitive opportunity to serve as a Customer Service Compliance Specialist. The selected competitive candidate will provide exceptional delivery of services to the agency’s Programs Operations Division.

Job responsibilities will include, but are not limited to:

This position provides operational support to the Customer Service Unit by interpreting and applying policies, procedures, and practices governing the programs administered by the Department of Medical Assistance Services.

The individual in this position will use state and federal guidelines, regulations, policies, and procedures to respond to provider and member appeal requests.

This individual will perform research, analyze data to resolve complex claims processing and billing inquiries originating from Medicaid Providers, and Medicaid members to respond to appeals received.

The individual in this position will also be responsible for preparing appeal summaries and attending agency appeals hearings.

In addition to those duties, the position will be responsible for inquires originating from the FOIA coordinator, call center, mail inquiries, and other internal and external entities.
Inquires may involve questions about routine claims processing issues, eligibility and enrollment status, and general program information.

The position you are applying for is an Hourly/Wage position. Hourly (wage) employees may not work more than an average of 29 hours a week and cannot exceed 1500 hours during their employment year. This position does not include health insurance, retirement or leave.

Located in beautiful Central Virginia, the Richmond area puts you just 2 hours from the Blue Ridge Mountains, Virginia Beach and Washington DC. To learn more about the Richmond, VA area visit: https://www.virginia.org/

The Department of Medical Assistance Services (DMAS) is working to improve the health and well-being of Virginians through access to high quality health care coverage.

DMAS wants talented individuals who can align their experience with the mission of the agency and its core values – service, collaboration, trust, problem solving and adaptability.

At the Department of Medical Assistance Services (DMAS) we encourage and promote that you Come as you are | Become who you want to be | That is our promise.

Minimum Qualifications

Competitive candidates will meet these minimum qualifications:

Knowledge of health care claims processing, billing and payment procedures of the Virginia Medicaid program and managed health care.

Experience resolving complex health care claims processing problems and carrying out research.

Knowledge and experience analyzing, interpreting, and applying federal, state laws and regulations.

Experience conducting analysis of written state and federal policies, procedures, and regulations.

Knowledge of Virginia Medicaid provider enrollment rules and regulations.

Knowledgeable of Medicaid Programs, the eligibility criteria and regulations associated with those programs.

Experience using spreadsheet, database, and word processing software.

Experience meeting deadlines.

Additional Considerations

There are no additional considerations for this position.

Special Instructions

You will be provided a confirmation of receipt when your application and/or résumé is submitted successfully. Please refer to “Your Application” in your account to check the status of your application for this position.

The Department of Medical Assistance Services (DMAS) is an Executive Branch agency that will adhere to all policies and procedures, to include the Commonwealth’s Department of Human Resource Management Policy 1.61 Teleworking.

You will be provided a confirmation of receipt when your application and/or résumé is submitted successfully. Please refer to “Your Application” in your account to check the status of your application for this position.

This position requires a fingerprint based Criminal History Background Check, applicable Education Checks, Work History Verification with references.

If you wish to apply for a job with the Department of Medical Assistance Services, an application and/or resume for employment must be submitted electronically through this website.

Mailed, faxed, emailed, or hand-delivered applications/resumes will not be accepted. Consideration for an interview is based solely on the relevant information presented in the state application and/or resume submitted before the closing date.

Applications and/or resumes should include relevant work history which indicates your qualifications for this position.

The Department of Medical Assistance Services practices fair and equal employment opportunity to all employees and applicants in accordance with applicable laws and regulations. It is our policy to prohibit discrimination on the basis of race, sex, color, national origin, religion, sexual orientation, gender identity, age, veteran status, political affiliation, genetics, or disability in the recruitment, selection, and hiring of its workforce. Qualified individuals with disabilities are encouraged to apply.

The Department of Medical Assistance Services is a V3 certified state agency that provides hiring preference to veterans and members of the reserves and/or National Guard in support of executive order 29, (2010). If you are a Veteran or Spouse of a Veteran or Active Military Member, DMAS encourages you to apply and respond accordingly on your state application.

Contact Information

Name: DMAS Talent Acquisition

Phone: 804-225-4407

Email: [email protected]

In support of the Commonwealth’s commitment to inclusion, we are encouraging individuals with disabilities to apply through the Commonwealth Alternative Hiring Process. To be considered for this opportunity, applicants will need to provide their Certificate of Disability (COD) provided by a Vocational Rehabilitation Counselor within the Department for Aging & Rehabilitative Services (DARS), or the Department for the Blind & Vision Impaired (DBVI). Veterans are encouraged to answer Veteran status questions and submit their disability documentation, if applicable, to DARS/DBVI to get their Certificate of Disability. If you need to get a Certificate of Disability, use this link: Career Pathways for Individuals with Disabilities, or call DARS at 800-552-5019, or DBVI at 800-622-2155.