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Company Name : Commonwealth of PA
Location : Warren County, PA
Position : HIPP Operations Specialist
Job Description : THE POSITION
The HIPP Program is looking for a highly motivated person to enroll medical assistance recipients into their employer’s health insurance. By purchasing the insurance through an employer we help the clients and also save money for the Commonwealth of PA. Responsible to determine cost effectiveness and enroll cost effective applicants into the HIPP Program. Responsible to maintain all enrolled cases to assure continuing eligibility and respond to case inquiries. This position is located within the HIPP section, Division of Third Party Liability, Bureau of Program Integrity.
DESCRIPTION OF WORK
10% – Respond to telephone inquiries and written inquiries from various types of program service providers, County Assistance Offices, inter and intra departmental agencies, and interested others, explaining the administrative processes and procedures for participation in the HIPP Program, the enrollment processes, the cost effectiveness determination process and the claims and premium payment processes for the HIPP program service delivery. 20% Review, analyze and evaluate employer group health insurance policies and employee benefit booklets to determine exact insurance coverage available to Medical Assistance recipients. Analyze and compare insurance premiums for specified coverage against projected annual Managed Care rates; negotiate with employers, unions, and/or insurance carriers to resolve issues; and enrollment dates. Determine cost effectiveness of employer group health plans (EGHP) and enroll eligible MA recipients into cost effective employer group health insurance. 25% Maintain enrolled HIPP cases by performing scheduled cost effectiveness re-evaluations. Respond to information obtained from change report forms and phone calls. Resolving HIPP status code reports; and other functions deemed necessary to assure that enrolled cases are properly maintained. Adjudicate overpayment/returned or undelivered checks. Develop and document detailed records for those cases determined no longer cost effective, and generate notices of discontinuance to recipients, employers, and County Assistance Offices. 5% Maintain a working knowledge of state and federal health insurance regulations as well as commercial insurance procedures. 10% – Contact employers of recipients enrolled in the Department’s Medical Assistance for Workers with Disabilities (MAWD) Program and arrange for MAWD Payments to be sent to the Department. Determine whether MAWD recipients are eligible for employer group health plans (EHGP); determine cost effectiveness of private insurance; negotiate to enroll qualified MAWD recipients in HIPP. Work Hours and Additional Information:
Full-time employment.
Work hours 8:00 am – 4:00 pm, Monday – Friday with a 30-minute lunch period.
Teleworking: You will have the opportunity to work from home (telework), part-time up to 3 days a week. In order to telework, you must have a securely configured high-speed internet connection. If you are unable to telework, you will have the option to report to the headquarters office in Warren.
REQUIRED EXPERIENCE, TRAINING & ELIGIBILITY
Qualifications:
Minimum Experience and Training Requirements – One year of experience as a Third Party Liability or Medical Assistance Program Technician; OR four years of experience in the review and analysis of medical insurance policies and premiums, reviewing and responding to inquiries relating to applicable service or benefits in health care insurance programs, health care services or Medical Assistance program services; OR an equivalent combination of experience and training.
Must meet PA residency requirement – For more information on ways to meet PA residency requirements, follow the link and click on Residency.
Do not submit resumes, cover letters, and similar documents. These documents will not be reviewed and the information contained therein will not be considered for the purposes of determining your eligibility for the position or to determine your score. Information to support your eligibility for the position must be provided on the application (i.e., relevant, detailed experience/education).
If you are claiming education in your answers to the supplemental application questions, you must attach a copy of your college transcripts for your claim to be accepted toward meeting the minimum requirements. Unofficial transcripts are acceptable.
Must be able to perform essential job functions.
Veterans: Pennsylvania law (51 Pa. C.S. §7103) provides employment preference for qualified veterans for appointment to many state and local government jobs. To learn more about employment preferences for veterans, go to www.employment.pa.gov/Additional%20Info/Pages/default.aspx and click the Veterans’ Preference tab or contact us at ra-cs-vetpreference@pa.gov.
Telecommunications Relay Service (TRS): 711 (hearing and speech disabilities or other individuals)
The Commonwealth is an equal employment opportunity employer and is committed to a diverse workforce. The Commonwealth values inclusion as we seek to recruit, develop, and retain the most qualified people to serve the citizens of Pennsylvania. The Commonwealth does not discriminate on the basis of race, color, religious creed, ancestry, union membership, age, gender, sexual orientation, gender identity or expression, national origin, AIDS or HIV status, disability, or any other categories protected by applicable federal or state law. All diverse candidates are encouraged to apply.
EXAMINATION INFORMATION
Completing the application, including all supplemental questions, serves as your exam for this position. No additional exam is required at a test center (also referred to as a written exam).
Your score is based on the detailed information you provide on your application and in response to the supplemental questions.
Your score is valid for this specific posting only.
You must provide complete and accurate information or:
your score may be lower than deserved.
you may be disqualified.
You may only apply/test once for this posting.
Your results will be provided via email.
Learn more about our Total Rewards by watching this short video!
Health & Wellness
We offer multiple health plans so our employees can choose what works best for themselves and their families. Our comprehensive benefits package includes health coverage, vision, dental, and wellness programs.*
Compensation & Financial Planning
We invest in our employees by providing competitive wages and encouraging financial wellness by offering multiple ways to save money and ensure peace of mind including multiple retirement and investment plan options.
Work/Life Balance
We know there’s more to life than just work! Our generous paid leave benefits include paid vacation, paid sick leave, six weeks of paid parental leave, military leave, and paid time off for most major U.S. holidays, as well as flexible work schedules and work-from-home opportunities.*
Values and Culture
We believe in the work we do and provide continual opportunities for our employees to grow and contribute to the greater good. As one of the largest employers in the state, we provide opportunities for internal mobility, professional development, and the opportunity to give back by participating in workplace charitable giving.
Employee Perks
Sometimes, it is the little “extras” that make a big difference. Our employees receive special employee-only discounts and rates on a variety of services and memberships.
For more information on all of these Total Rewards benefits, please visit www.employment.pa.gov and click on the benefits box.
Eligibility rules apply.
This post is listed Under Pennsylvania jobs
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