Medical Operations Program Assistant II

South Dakota AG; Sioux Falls (SD); Presencial; USD 32 000 - 41 000; Tempo integral

Vantagens oferecidas por esta oferta de emprego

Veterans’ Preference

Health insurance option

11 paid holidays

Vacation and sick leave

Retirement benefits

Resumo da oferta

South Dakota Department of Social Services is seeking an Operations Program Assistant II for the Medicaid program. The role focuses on providing high-quality customer service to Medicaid providers and supporting day-to-day data entry and claims processing operations.

The position involves reprocessing decisions, portal support, staff training, and data quality reporting. It requires strong communication skills and the ability to manage multiple tasks while meeting deadlines.

Qualificações

• Experience in data entry, claims processing, or customer service.
• Medicaid, healthcare billing or medical claims experience preferred.

Responsabilidades

• Determine appropriateness of requests to reprocess claims.
• Approve or deny provider claim reconsideration requests through the Medicaid Online Portal.
• Monitor inquiries via the provider portal and DSS email system.
• Support training on claim entry into the Portal and direct advanced inquiries as needed.
• Compile and report data entry errors and communicate issues to leadership.
• Monitor daily claims and the workflow to ensure timely processing.

Conhecimentos

Verbal communication

Written communication

Policy interpretation

Data gathering & analysis

Relationship building

Multitasking

Portal navigation

Independent work

Ferramentas

Provider portals

Email systems

Data management tools

Descrição da oferta de emprego

Job ID: 38212

Agency: Department of Social Services / Medical Services

Location:Pierre, SD or Sioux Falls, SD

Salary: $23.56-$29.44 Hourly, depending on qualifications

Pay Grade: H

Closing Date: 11.10.2026

This is a Full-Time 40 Hours Weekly position with the Department of Social Services. For more information on the DSS, please visit https://dss.sd.gov .

Summary

The Division of Medical Services is seeking a highly motivated individual to serve as an Operations Program Assistant II for the South Dakota Medicaid Program. This position is responsible for providing high-quality customer service to South Dakota Medicaid providers and will serve as a key resource in the day-to-day operations of the Medicaid Data Entry team.

Responsibilities include determining appropriateness of requests to reprocess claims, and approving or denying provider claim reconsideration requests made through the Medicaid Online Portal. This position will also monitor and respond to inquiries received through the provider portal and DSS email system, support training on claim entry into the Portal, and as needed, direct advanced inquiries to the appropriate personnel. This position is also responsible for compiling and reporting data entry errors and communicating recurring issues to the Operations Manager and CAPS Supervisor to support appropriate staff training. Additional duties include monitoring daily claims received and the workflow to ensure the claims are processed in a timely fashion.

This position will assist with processing complex claims and may provide other support, as assigned, to the claims processing and data entry teams as needed.

The Ideal Candidate Will Have

Candidates should have experience in data entry, claims processing, or customer service. Experience with Medicaid, healthcare billing or medical claims preferred but not necessary.

Knowledge, Skills, And Abilities Of

• use written words and skillful verbal communications;
• accurately interpret and apply policies to determine appropriate outcomes of claim reconsiderations;
• establish, build, and maintain cooperative and productive internal and external relationships; demonstrate compassion, respect, courtesy, and tact in all interactions;
• gather and analyse data to identify problems and potential issues, and develop and implement appropriate resolutions;
• communicate information clearly and concisely, both verbally and in writing, while keeping all appropriate parties informed;
• adapt effectively to changing policies and procedures;
• manage multiple tasks simultaneously while maintaining accuracy and meeting deadlines;
• navigate provider portals, email systems, and data management tools with confidence;
• work independently while also providing support to team members.

Additional Requirements

This position is eligible for Veterans’ Preference per ARSD 55:10:02:08.

NCRC: If you possess a National Career Readiness Certificate, please submit the certificate with your application. For more information on how to acquire a National Career Readiness Certificate contact a South Dakota Department of Labor and Regulation Job Service Office. A certificate is not necessary to be considered.

The State of South Dakota does not sponsor work visas for new or existing employees. All persons hired will be required to verify identity and eligibility to work in the United States and complete an Employment Eligibility Verification, Form I-9. The State of South Dakota as an employer will be using E-Verify to complete employment eligibility verification upon hire.

The State of South Dakota offers $0 premium employee health insurance option plus eleven paid holidays, generous vacation and sick leave accrual, dental, vision, and other insurance options, and retirement benefits. You can view our benefits information here . This position is a member of Class A retirement under SDRS.

South Dakota Bureau of Human Resources and Administration

Telephone: [phone] Email: [e-mail]

http://bhr.sd.gov/workforus

"An Equal Opportunity Employer"