Medicaid Operations Specialist: Claims & Data Entry

Sdsoybean; Sioux Falls (SD); On-site; USD 32,000 - 41,000; Full time

Job summary

The Department of Social Services / Medical Services in Pierre, SD or Sioux Falls, SD seeks an Operations Program Assistant II to support the Medicaid program. You will assist with data entry, provider inquiries, and claims processing while ensuring timely, accurate resolution of issues.

Qualified candidates will have data entry or claims experience, knowledge of Medicaid or healthcare billing is a plus, and strong communication skills to liaise with providers and internal teams.

Qualifications

• Experience in data entry, claims processing or customer service.
• Knowledge of Medicaid, healthcare billing or medical claims preferred.
• Ability to interpret policies and determine claim outcomes.
• Strong written and verbal communication with internal and external stakeholders.

Responsibilities

• Determine appropriateness of requests to reprocess claims and approve/deny reconsiderations.
• Monitor inquiries via the provider portal and DSS email system.
• Assist training on claim entry into the Portal and route advanced queries.
• Compile and report data entry errors and communicate recurring issues for training.
• Monitor daily claims and workflow to ensure timely processing.

Skills

Data entry

Claims processing

Customer service

Provider portal navigation

Communication

Team coordination

Tools

Medicaid Online Portal

Provider portal

Data management tools

Job description

The Department of Social Services / Medical Services in Pierre, SD or Sioux Falls, SD seeks an Operations Program Assistant II to support the Medicaid program. You will assist with data entry, provider inquiries, and claims processing while ensuring timely, accurate resolution of issues.

Qualified candidates will have data entry or claims experience, knowledge of Medicaid or healthcare billing is a plus, and strong communication skills to liaise with providers and internal teams.