Health Care Claims Manager

THIS IS A NEW ASSEMBLED EXAMINATION.  The eligible list resulting from this examination will cancel any existing list and may last approximately one year, but can be extended. 

Supplemental Questionnaire:  A properly completed Supplemental Questionnaire must be submitted with each application.  Applications and Supplemental Questionnaires must be in the possession of the Human Resource Services Department by 5:00 p.m. on the Last Day for Filing. Applications will only be accepted on-line. Postmarks are not accepted.  Failure to submit the Application or Supplemental Questionnaire will result in disqualification.

THE AGENCY
The Health Care Services Agency of Alameda County, Behavioral Health Care Claims Processing Center has a career opportunity for experienced Health Care Claims professionals to become part of a team that authorizes, adjudicates and processes payments to a large network of contracted Managed Care Mental Health providers.  Such services are provided through a referral process for Medi-Cal, Child and Family Service and Indigent clients in Alameda County.  The Claims Processing Center provides a fast-paced, cohesive team atmosphere and is dedicated to processing payments to providers timely and seamlessly.  Experienced full-cycle claims processing professionals interested in supporting our Mental Health provider’s payment process while they provide a crucial and essential service to the Alameda County community are encouraged to learn more about this opportunity!

It is the mission of Behavioral Health Care Services to maximize the recovery, resilience and wellness of all eligible Alameda County residents who are developing or experiencing serious mental health, alcohol, or drug concerns. We envision communities where people realize their potential, and where stigma and discrimination against those with mental health, alcohol and/or drug issues are a thing of the past.

Only through exemplifying the following Alameda County Behavioral Health Care Services values will we be successful:

ACBHCS

Access -  where every door is the right door for welcoming people with complex needs;

Consumer and Family Empowerment - through shared decision‐making best practices, that clinically produce effective outcomes;

Best Practices - business excellence that uses public resources cost‐effectively;

Health and Wellness - by integrating emotional, spiritual and physical health care;

Culturally Responsive - appropriate services built on the strengths and life experiences of culturally diverse consumers and their families;

Social Inclusion - utilizing advocacy and education to eliminate stigma, discrimination, isolation, and misunderstanding of persons with mental illness and substance abuse.

For more information about the department of Behavioral Health Care Services, please visit the departmental website and/or Annual Budget Document found on acgov.org.
 
THE POSITION
Under general supervision, to plan, coordinate and manage the activities of the Behavioral Health Care Claims Processing Center; to ensure that operational procedures are in compliance with policies and procedures of the Behavioral Health Plan and generally accepted claims processing practices and standards; and to perform other related duties as assigned.

Distinguishing Features
This single position is located in the Behavioral Health Care Services, Claims Processing Center and reports to the Supervising Financial Services Specialist. The Health Care Claims Manager plans, coordinates and manages the activities of the Claims Processing Center and exercises full supervisory responsibility for this unit. This class is distinguished from the lower class of Health Care Claims Examiner II in that the latter processes claims for payment and verifies eligibility for a variety of insurances plans/programs, which does not include supervisory responsibilities. It is further distinguished from the next higher class of Supervising Financial Services Specialist, in that the latter has overall administrative responsibilities for the Provider Relations Unit.

THE IDEAL CANDIDATE
In addition to the minimum qualifications and knowledge and skills listed above, ideal candidates for this position will also exemplify the following critical attributes for success:

• A quality oriented individual who accomplishes tasks by being attentive to details and who understands the importance of checking processes and tasks over time in order to minimize consequence of errors.  
• Someone who is analytical, resourceful, and skilled at gathering and synthesizing information from a variety of stakeholders and sources in an objective, unbiased manner to reach a conclusion.
•  A competent decision maker capable of taking action consistent with all available facts, constraints, and probable consequences in a fast paced environment by identifying and understanding issues, problems, and opportunities, and comparing data from different sources to draw conclusions.
• An effective communicator who conveys information and in a manner that meets audience needs; someone able to develop and maintain effective relationships with others and who relates well to people of diverse cultures, interpersonal styles, abilities, motivations, or backgrounds even in times of conflict.
• Someone who is agile and capable of smoothly and quickly adapting to change, is open to different perspectives, and who adjusts effectively to work within new work structures, processes, requirements, or cultures.
• An experienced health care claims professional who keeps up with terminology and current developments and trends in health care claims processing and who has achieved sufficient technical skill and/or knowledge in order to process claim payments and verify eligibility for a variety of insurance plans/programs.
• Someone who is well organized and able to plan and coordinate work activities for themselves and their direct-reports, successfully managing several tasks at once to ensure that work is completed efficiently.
• Someone who has strong supervisory and team building skills and is able to handle all work matters in a highly confidential, objective and professional manner.
  

Either I

The equivalent of two years full-time experience in the Health Care Claims Examiner II or higher classification in the Alameda County classified service. (Non-classified includes District Attorney’s Office, Hospital Authority, and the Consolidated Courts.)

Or II

The equivalent of three years full-time experience in reviewing, evaluating, editing and processing claims for payments, and determining eligibility for a variety of insurance plans/programs in a health care environment. One year of the above experience must include lead and/or supervisory experience.

NOTE: The Civil Service Commission may modify the Minimum Qualifications in the announcement of the examination.

NOTE: The level and scope of the following knowledge and abilities are related to duties listed under the "Examples of Duties" section of this specification.

Knowledge of:

• Management principles and practices, including work planning, employee supervision and resource allocation
• Applicable health care laws and regulations
• Parameters of a provider’s contract obligations.
• Current policies and requirements for an array of administered insurance plans (e.g. Medi-Cal, Healthy Families, and Children’s Indigent Plan) and other regulations as they relate to insurance benefit plan/program eligibility.
• Basic policies and operations of health care insurance plans.
• Federal, State and local health care rules and regulations as they relate to claims processing.
• Computer applications related to the work.
• Office administrative practices and procedures, including records management and the operation of standard office equipment.
• Basic mathematical computation.

Ability to:

• Plan, supervise, review and evaluate the work of staff.
• Interpret, explain and apply complex regulations, policies and procedures.
• Prepare clear, accurate and effective reports, correspondence, policies, procedures and other written materials.
• Represent the department and the County in meetings with others and make effective presentations to diverse groups.
• Organize, prioritize, and coordinate multiple activities to meet critical deadlines
• Direct the maintenance of accurate records and files.
• Exercise sound independent judgment within established policies and guidelines.
• Exercise interpersonal sensitivity to establish and maintain effective working relationships with staff, clients, other agencies, and the public.
• Analyze, evaluate and draw logical conclusions.
• Maintain confidentiality.
• Communicate effectively orally and in writing.
• Work independently and adapt to change.

Alameda County offers a comprehensive and competitive benefits package that affords wide-ranging health care options to meet the different needs of a diverse workforce and their families. We also sponsor many different employee discount, fitness and health screening programs focused on overall well being.  These benefits include but are not limited to*:

For your Health & Welfare Benefits

• Medical – HMO & PPO Insurance
• Dental – PPO & DHMO Insurance  
• Vision
• Basic Life Insurance 
• Supplemental Life Insurance (with optional dependent coverage) 
• County Allowance (Employer Credit)
• Health Flexible Spending Account
• Dependent Care Flexible Spending Account
• Accident, Critical Illness & Hospital Indemnity
• Long Term Care Insurance
• Employee Assistance Program

For your Financial Future

• Short-term Disability Insurance
• Long-Term Disability Insurance
• Retirement Plan – (Defined Benefit Pension Plan)
• Deferred Compensation Plan

For your Work/Life Balance

• 11 paid holidays
• Vacation and sick leave accrual
• Vacation purchase program
• Management Paid Leave**
• Group Auto/Home Insurance
• Commuter Benefits Program
• Group Legal
• Guaranteed Ride Home
• Employee Wellness Program (e.g. At Work Fitness, Incentive Based Programs, Gym Membership Discounts)
• Employee Discount Program (e.g. theme parks, cell phone, etc.)
• Child Care Resources
• 1^st United Services Credit Union 

*Eligibility is determined by Alameda County and offerings may vary by collective bargaining agreement.  This provides a brief summary of the benefits offered and can be subject to change.

** Non-exempt management employees are entitled to up to three days of management paid leave. Exempt management employees are entitled to up to seven days of management paid leave.