Medicaid Claims Specialist

ND Health and Human Services; North Dakota; Remote; USD 45,000 - 60,000; Full time

Job summary

ND Health and Human Services is seeking a Medicaid Claims Specialist to evaluate, process and adjust medical, dental, institutional and HCBS waiver claims. This remote North Dakota role requires accuracy, attention to Medicaid policies, and strong problem-solving.

A high school diploma or GED and at least two years of medical claims processing experience are required. The position offers blended work options within North Dakota, with relocation considerations for out-of-state candidates.

Qualifications

• Must have a high school diploma or GED and a minimum of two years of medical claims processing experience.
• Experience evaluating, processing and adjusting medical, dental, institutional and HCBS waiver claims.

Responsibilities

• Evaluate, process and adjust medical, dental, institutional and HCBS waiver claims.
• Apply Medicaid policies and interpret guidelines to ensure accurate claims processing.
• Collaborate with provider claims teams to ensure compliance and timely processing.
• Identify discrepancies and resolve issues with a proactive, detail-oriented approach.

Skills

Detail-oriented

Analytical

Medicaid policy knowledge

Education

High school diploma or GED

Job description

Medical Services is seeking a Medicaid Claims Specialist to work remote in North Dakota. As a Medicaid Claims Specialist, you will be responsible for evaluating, processing and adjusting all medical, dental, institutional and Home and Community-Based Service (HCBS) waiver claims. This includes applying Medicaid policies and interpreting various program guidelines to ensure accurate claims processing. You will work directly with provider claims to ensure compliance with Medicaid guidelines, ensuring they meet all necessary service expectations. To thrive in this position, you must be detail-oriented, analytical and possess a strong understanding of Medicaid policies. You should have excellent problem-solving skills to identify and resolve discrepancies efficiently, while maintaining the highest standards of accuracy and compliance. Strong communication and teamwork abilities are essential, as you will collaborate with various teams to address claim issues and ensure timely processing. You have a proactive attitude toward learning new policies and staying updated on system changes. To be considered for the Medical Claims Specialist position, you must have a high school diploma or GED AND a minimum of two (2) years of medical claims processing experience.

Location

ND HHS utilizes a blended workplace model. This position may work from home within North Dakota or bordering cities. Candidates outside of North Dakota must be willing to relocate to the state.

About HHS

ND HHS strives to make North Dakota the healthiest state in the nation by reinforcing the foundations of well-being: physical, economic, and behavioral. The keys to success are the 2800 committed, team members who are guided by a simple but powerful belief: when we lead with light, we create systems and services rooted in hope, clarity, and possibility. Their work is supported with more than $6 billion in funding from nearly 400 different federal, state, and special sources. To succeed in this role, you must lead with LIGHT - leading with hope, instilling purpose and meaning, galvanizing gratitude, honoring health, and talking, walking and teaching civility, kindness and love for all.

About Team ND

"Far and away the best prize life offers is the chance to work hard at work worth doing." - Theodore Roosevelt. More than 7,500 talented, hard-working people across sixty-three agencies have come together as Team North Dakota. At Team ND, we are driven to succeed through gratitude, humility, curiosity and courage. Our purpose is to empower people, improve lives, and inspire success. Join us in being legendary.

Total Rewards:

The State of North Dakota is committed to providing team members with a strong and competitive rewards package that support you, your health and your family. Considering a new position on Team ND? How does your current position stack up? Use our Total Rewards Calculator to estimate.

Applicants must be legally authorized to work in the United States. The Department of Health & Human Services does not offer or provide sponsorships. This employer participates in E-Verify. Please visit the following website for additional information HHS ND Careers E-Verify. A copy of your qualifying degrees transcript and any applicable certifications or licensures must be provided at the time of an interview.

Equal Employment Opportunity

The State of North Dakota and this hiring agency do not discriminate on the basis of race, color, national origin, sex (including sexual orientation and gender identity), genetics, religion, age or disability in employment or the provisions of services and complies with the provisions of the North Dakota Human Rights Act. As an employer, the State of North Dakota prohibits smoking in all places of state employment in accordance with N.D.C.C. Sect. 23-12-10.