The Department of Human Services (DHS) is about safety, health and independence for all Oregonians. We help Oregonians in their own communities achieve well-being and independence through opportunities that protect, empower, respect choice and preserve dignity. We protect children who are abused or neglected. We provide long-term care services to seniors and people with disabilities. We help low-income people along the road to self-sufficiency with health coverage, job preparation, childcare and other supports. Our services are delivered in the least restrictive setting and in partnership with communities. We serve many diverse people and communities across Oregon and are focused on creating an inclusive work environment and on ensuring that the results we achieve for all Oregonians are equitable. We are absolutely committed to ongoing innovation in the delivery of services, and we are committed to recruiting, developing and retaining dedicated employees.
This employment opportunity is with Information Technology Business Supports, which is part of the Department of Human Services. There is one permanent full-time opening located in Salem (Summer Street NE) . This position is represented by a union.
This recruitment announcement will be used to establish a list of qualified candidates to fill the current vacancy and may be used to fill future vacancies as they occur.
Please be aware that due to the economic downturn and subsequent state budget short-fall these positions may be required to take furloughs in the biennium 2011-2013.
Duties & Responsibilities:
The primary purpose of this position is to ensure accurate and timely case coding necessary to support waiver enrollment, client service authorizations, and payments. Assist Community Developmental Disability Programs (CDDP) and Adult Support Services Brokerages in resolving case coding entries that prevent waiver enrollment or access to services. Assist the provider community servicing clients with Developmental Disabilities in obtaining correct and timely payment for services rendered, in accordance with state and federal rules and regulations.
Providers serve clients of the Department of Human Services, and submit claims through the Express Payment and Reporting System (eXPRS) or the Client Process Monitoring System (CPMS). The provider population is diverse, ranging from single providers to large corporations and include other governmental entities, not-for-profit provider organizations, and for-profit corporations. The individual in this position provides direct assistance to contractors who administer community-based service programs for the Developmentally Disabled population, by the direction of the Department of Human Services.
Assessing and processing client Developmental Disability and waiver eligibility case coding data
Using the information submitted by community business partners, and following current central office and Developmental Disabilities (DD) provider technical assistance unit procedures, maintain all Developmental Disability service enrollment and DD service eligibility data, Title XIX (TXIX) waiver eligibility data, level of care determinations, client demographic data, and service payment information in Client Index (CI), Center for Medicare and Medicaid Services (CMS), DD eligibility screens, and CPMS.
Utilizing client demographic, service, and eligibility information located in various systems (e.g., CMS, CI, CPMS, eXPRS, 512 system, Aging and People with Disabilities (APD)/DD service eligibility system, MMIS and Oregon Access) and through analysis and comparison of these data with the information submitted by business partners and the central office Diagnosis & Eligibility Coordinator, determine the appropriate DD eligibility coding, waiver coding and date segment entries required on all service eligibility case records for individuals with developmental disabilities.
Enter the correct DD service eligibility and waiver coding with the correct date segments to the correct service eligibility screens.
Following successful waiver enrollment coding, complete the Waiver Status and Dates section of TXIX forms, and compile attachments per unit procedures. Return the Waiver form to the Community Developmental Disabilities Program (CDDP).
Track and log all incoming and outgoing information, as well as the date the associated coding activity was completed for each piece/set of service, eligibility, rate and demographic information submitted.
Coordinate with Aged and Physically Disabled (APD) Field Offices and CDDP offices to address and resolve financial and service eligibility case coding conflicts
Communicate verbally and/or via email with a variety of state, County, and Brokerage personnel, regarding client Waiver enrollment status or client level of care determination coding entries and date segments. Explain policies and procedures regarding DD eligibility and waiver assignment coding, and the impact this coding has upon service authorizations and payments, based upon DHS policies and various state and federal regulations.
Research and analyze suspected service or waiver eligibility coding issues. Review client information located in various systems (e.g., Oregon Access, CI, CMS, MMIS, eXPRS, CPMS, ORKIDS, Department of Justice (DOJ) info systems, birth/death records, Department of Motor Vehicles (DMV), etc) to identify and assess the impact of data conflicts. These data conflicts may include eligibility determination discrepancies, name and other identifying information mismatches, age data errors, service enrollment/termination data errors, residency data conflicts, and other types of data discrepancies.
Following analysis, make decisions regarding course of action to be taken to correct waiver or service eligibility coding conflicts or other issues impacting service authorizations, payments, or financing of claims. Update CI, CMS, CPMS, DD service enrollment, and DD service eligibility systems with the corrected information. Provide information to business partners (providers, CDDP case managers, Brokerage Personal Agents), APD field office staff and central office personnel as needed to support resolution of these issues. Resolutions must occur quickly to prevent service authorization and payment delays, and financing errors on claim payments.
Verify the data in any materials submitted in case coding resolution activity, and then process all service and waiver coding corrections, per existing State and Federal rules and regulations, as well as unit procedure guides.
Document on submitted forms (per unit procedures) any data corrections required, return the forms to the sending agency with instructions regarding corrections required within their internal data systems.
Reprocessing claims affected by case coding resolution activity
As case coding issues are analyzed and resolved, reprocess any affected claims in eXPRS, or submit refinancing requests for claims paid outside eXPRS.
Service Desk Tier Two support
Monitor the eXPRS service desk cache and address tickets which fall within the parameters of Tier Two assistance. Contact the identified user, determine the issues to be addressed, analyze the problem and assist eXPRS users in resolving issues. Typical Tier Two issues include service authorization errors, claim processing problems, payment errors, and screen access difficulties. Complete all necessary documentation in the system.
CPMS Expenditure Report Data Entry
Utilizing the Client Process Monitoring System expenditure reports submitted by CDDP offices and Brokerages, enter the data regarding fund expenditures to CPMS.
Process the CPMS error job, making any necessary corrections to address data conflicts or entry errors.
Service payment corrections
Utilizing eXPRS, CPMS, CMS, Decision Support/Surveillance and Utilization Review System (DSSURS) and the APD service eligibility system, assist the DD System Coordination Unit’s Quality Assurance Specialist in researching, analyzing, and resolving service payment or service financing errors identified following thorough review of various system reports produced in Central Office DD Systems Coordination Unit.
Research, analyze and resolve suspected payment errors reported by DHS Accounting, the Office of Information Services and other Department offices, CDDPs, Brokerages, or providers.
Once analysis and verification is complete, process all service payment corrections per existing State and Federal rules and regulations and following the unit procedure guidelines.
Provider Claim Adjustments
Analyze and process provider requests for claim adjustments due to errors in Other Incurred Medical expense processing or Client Liability updates. Obtain verification from the local APD field office regarding the appropriate adjustment required. Make adjustments to claims as directed by the local APD office, and maintain all documentation in support of the adjustment action taken.
Quality Assurance Assistance
Assist the Quality Assurance (QA) Specialist in special projects as assigned, using a variety of systems and functions at a technical or administrative level requiring decision-making within established laws, rules, policies and procedures.
Assist the QA Specialist as directed in collecting, organizing, and preparing data in both narrative and statistical report formats. Examples of this work include researching payments in question in Settlement documents, development of new business procedures and forms, determining impact of new business procedures.
Attend all team and unit meetings
Perform other duties, as assigned by Supervisor
Employee is expected to perform in a high-volume setting with quickly-changing priorities and ever-evolving procedures. Employee must be able to work on multiple tasks simultaneously, and respond effectively to changes in time lines and task requirements. Employee must be able to respond effectively to verbal instructions, cope with frequent interruptions, and adapt to moderate noise levels. Employee must be able to gather information required to complete assigned tasks and deliver within specified time limits. Employee must be able to process and respond effectively to direction from several areas of the unit. Employee must be able to work effectively and efficiently as a team member in completing assigned tasks or special projects, many of which have inflexible and competing deadlines. Employee must be self-directed and must be able to prioritize work on a daily basis, according to many set and inflexible deadlines. Employee must be able to re-prioritize work as circumstances change, in order to meet both pre-set or emerging deadlines.
Qualifications & Desired Attributes:
Your application materials, including your answers to the 'Supplemental Questions' will be reviewed to determine if you meet the minimum qualifications and how you meet the desired attributes for the position to which you have applied. Your answers to the supplemental questions must be reflected in your application.
Three years of clerical/secretarial experience which included : Two years at a full performance level performing typing, word processing, or other generation of documents and lead work responsibility or coordination of office procedures.
Courses or training in Office Occupations or Office Technology may be substituted for up to one year of the clerical/secretarial experience.
No substitution will be made for the two years at the full performance level.
Effective communication skills in a business setting
Experience responding quickly and professionally to inquiries from customers, community business partners and agency staff in a business setting.
Experience participating in the exploration, analysis and decision-making regarding business process changes.
Experience utilizing mainframe and modular applications to retrieve and analyze information.
Experience handling competing or quickly changing priorities to meet differing critical deadlines and ever changing procedures.
Ability to work within a team environment, but also independently.
Attention to detail and accuracy.
Only the candidates whose experience most closely match the qualifications and desired attributes of this position will be invited to an interview.
IMPORTANT NOTICE – Email Addresses Now Required
The state of Oregon is now requiring all applications have a valid email address.
If you do not currently have an email address and do not know where to go to get one please refer to our Applicant E-Recruit FAQ's web page. Click on the link below to go directly to question #14 to view several internet providers where you can get a free e-mail account. The state of Oregon does not endorse any particular provider.
Applicant E-Recruit FAQ's
If you are offered employment, the offer will be contingent upon the outcome of an abuse check, criminal records check and driving records check, and the information shall be shared with the DHS, Office of Human Resources (OHR). Any criminal or founded abuse history will be reviewed and could result in the withdrawal of the offer or termination of employment.
DHS will communicate with all applicants via e-mail.
If you need assistance to participate in the application process, you are encouraged to call 503-945-5698 (voice) 8:00 a.m. and 5:00 p.m. (Pacific Time) Monday through Friday. TTY users please use the Oregon Telecommunications Relay Service: 1-800-735-2900.
If you need assistance with adding attachments to your profile or to a specific job posting please go to Adding and Removing Attachments to a Profile and Job Posting for further instructions. This quick help guide can also be found on the State Jobs Page by clicking in the Applicant E-Recruit FAQ's then click on Applicant Profile Maintenance.
PLEASE CONSIDER JOINING US!
The Oregon Department of Human Services is committed to affirmative action, equal employment opportunity and workplace diversity.
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