Administrative Specialist/Appeals Administrative Specialist

State of North Carolina; Wake Forest (NC); On-site; USD 39,000 - 69,000; Full time

Job summary

The North Carolina Department of Health and Human Services (DHHS) is seeking an Administrative Specialist I to provide administrative support to the Due Process operations and Appeals Team within the Health Benefits division. The role involves handling inquiries, preparing reports, managing calendars, and supporting contract management and billing processes for Medicaid-related activities.

Candidates must meet the minimum education and experience requirements.

Qualifications

• High school diploma or GED and two years of related administrative experience; or equivalent education and experience.
• Experience with customer outreach and preparing data reports is preferred.
• Familiarity with contract management and billing for medical claims is a plus.

Responsibilities

• Provide administrative support to the Due Process and Appeals Team.
• Handle telephone inquiries, expedited appeal requests, and correspondence.
• Prepare calendar meetings, attachments, and related documentation.
• Maintain reports, files, and contract management records.

Skills

Customer outreach

Data reports

Contract management

Billing / claims

Education

High school diploma or GED

Job description

Agency

Dept of Health and Human Services

Division

HEALTH BENEFITS

Job Classification Title

Administrative Specialist I (S)

Position Number

65024479

Grade

NC08

About Us

The North Carolina Department of Health and Human Services (DHHS) is one of the largest, most complex agencies in the state, and has approximately 17,000 employees. It is responsible for ensuring the health, safety, and well-being of all North Carolinians, providing human service needs for special populations including individuals who are deaf, blind, developmentally disabled, and mentally ill, and helping poor North Carolinians achieve economic independence.

Description of Work

The primary purpose of this position is to provide administrative support to the Due Process operations and Appeals Team. Subject areas for Administrative Specialist I include provider reconsiderations, expedited hearing requests, Medicaid Direct and Managed Care appeals. This position also maintains documentation of activities, reports, correspondence, policies, and communication files. This position works directly with handling telephone inquiries, expedited appeal requests, statistical reports, contract management, provider reconsideration requests, and internal operations. The support activities include answering and responding to telephone calls/messages/emails, collecting and distributing mail, drafting beneficiary and vendor correspondence, preparation of calendar meetings and their applicable attachments, filing, copying, scanning, formatting reports, and other activities as directed.

Knowledge Skills and Abilities/Management Preferences

Salary Grade Range $39,244 - $68,679

Recruitment Range $39,244 - $47,210

Candidates now meet the minimum qualifications of a position if they meet the minimum education and experience listed on the vacancy announcement.

The Knowledge, Skills, and Abilities (KSAs)/ Management Preferences are not required. Applicants who possess the following skills are preferred:

• Experience with customer outreach
• Experience with creating data reports
• Experience with contract management
• Experience with billing or payment of medical claims

Physical Requirements:

Able to lift 20 pounds

Posting closes at 11:59 p.m. the night before the closing date

Position is funded in part through federal funds

About the NC Division of Health Benefits:

The Division of Health Benefits (DHB)within NCDHHS is committed to advancing innovative solutions that improve health, promote well-being and foster independence for all North Carolinians. DHB manages and oversees North Carolina Medicaid and other programs that provide access to services and supports for parents, children, seniors, people with intellectual / developmental disabilities, and behavioral health, substance use and traumatic brain injury disorders. With a budget over $27 billion in state and federal funds per fiscal year, DHB ensures that more than 108,000 enrolled providers are reimbursed for delivering covered services to 3.1 million beneficiaries.

All positions in the Division of Health Benefits are exempt from the State Human Resources Act (G.S. 126) except for the provisions of Articles 6 and 7 per HB 372 Section 20.

Compensation and Benefits:

The State of North Carolina offers excellent comprehensive benefits. Employees can participate in health insurance options, standard and supplemental retirement plans, and the NCFlex program (numerous high-quality, low-cost benefits on a pre-tax basis). Employees also receive paid vacation, sick, and community service leave. In addition, paid parental leave is available to eligible employees. Visit website for benefits.

Supplemental Contact Information:

The North Carolina Department of Health and Human Services (DHHS) is an Equal Opportunity Employer that embraces an Employment First philosophy, which consists of complying with all federallaws, state laws, and Executive Orders. We are committed to reviewing requests for reasonable accommodation at any time during the hiring process or while on the job. For more information about DHHS: https://www.ncdhhs.gov/.

DHHS uses the Merit-Based Recruitment and Selection Plan to fill positions subject to the State Human Resources Act with the most qualified individuals. Hiring salary will be based on relevant qualifications, internal equity, and budgetary considerations pertinent to the advertised position.

In accordance with the Governor’s Executive Order 303, our agency supports second-chance employment for individuals who were previously incarcerated or justice-involved. We invite all potential applicants to apply for positions for which they may be qualified.

Minimum Education and Experience

Some state job postings say you can qualify by an “equivalent combination of education and experience.” If that language appears below, then you may qualify through EITHER years of education OR years of directly related experience, OR a combination of both. See the Education and Experience Equivalency Guide for details.

• High school diploma or General Educational Development (GED) diploma and two years of related administrative experience; or
• equivalent combination of education and experience.

EEO Statement

The State of North Carolina is an Equal Employment Opportunity Employer and dedicated to providing employees with a work environment free from all forms of unlawful employment discrimination, harassment, or retaliation. The state provides reasonable accommodation to employees and applicants with disabilities; known limitations related to pregnancy, childbirth, or related medical conditions; and for religious beliefs, observances, and practices.

ADA Accommodations

Consistent with the Americans with Disabilities Act (ADA) and the Pregnant Workers Fairness Act (PWFA), DHHS is committed to the full inclusion of all qualified individuals. As part of this commitment, DHHS will ensure that people with disabilities, or known limitations covered by the PWFA, are provided with reasonable accommodation. If reasonable accommodation is needed to participate in the job application or interview process, please contact the person indicated below.