Job Announcement: Health Care Claims Examiner II (2024)

THISIS A NEW ASSEMBLED EXAMINATION.The eligible list resulting from this examination will cancel any existing listand may last approximately one year but can be extended.

Applications must be in the possession of theHuman Resource Services Department by 5:00 p.m. on the Last Day forFiling.

Applications will only be accepted online.

THECOUNTY

Alameda County, located on the east side of San Francisco Bay, isCalifornia's seventh-largest county. The County employs 9,700 full-timeemployees and operates on an annual budget of $3.4 billion. Oakland, the Countyseat, is California's eighth-largest city. One and a half million peoplecall Alameda County home and live in a variety of incorporated cities,unincorporated communities, and rural areas. As a major urban county,Alameda provides a full range of services to its citizens. The County isa blend of culturally and ethnically diverse communities, and its mixture ofcosmopolitan and suburban areas provides the perfect environment for familiesand their active lifestyles. The County offers extensive culturalresources, countless recreational opportunities, and an array of fine publicand private colleges and universities.

ALAMEDACOUNTY HEALTH

Alameda County Health is the local government agency thatpromotes and protects the health and well-being of all who live, work, learn,and play in Alameda County. We coordinate services and cultivate partnershipswith community organizations and providers to help ensure access, organize, anddeliver health care and services to people with Medi-Cal and without insurance,support resilient communities, and improve health for all. We focus on healthequity by developing programs and systemic solutions that reduce disparitiesfor the people and communities we serve.

Alameda County Health’s departments and programs focus onservices and support that provide care for the whole person.

• The Behavioral Health Department provides mental health and substance use services for people with Medi-Cal and without insurance and supports people along their path to wellness, recovery, and resilience.
• The Environmental Health Department works to keep our air, water, and food safe; it regulates, protects, and promotes the health of everyone in Alameda County by enforcing environmental health codes to reduce exposure to toxins and diseases.
• The Public Health Department focuses on community and population-level health, preventing and addressing root causes of health inequity across a range of communicable and chronic diseases.
• Alameda County Health also provides services through Housing and Homelessness Services, Emergency Medical Services Agency, HealthPAC, and Healthy Schools and Communities.

BEHAVIORALHEALTH DEPARTMENT

Aspart of Alameda County Health, the Behavioral Health Department supports peoplewith Medi-Cal and without insurance living with serious mental illness andsubstance use conditions along their path toward wellness, recovery, andresiliency. We provide services through a network of contracted mental healthand substance use providers and administer the State’s resources and trainingfor behavioral health providers, case managers, and other healthcareprofessionals. We advocate for our patients and families and create space forpersonal engagement in their care.

We areoutpatient specialists for mental health services for older adults and youth,substance use providers and treatment program specialists, advocates forquality improvement and patients’ rights, and psychiatric and integrated healthcare providers.

For more information about Alameda County Behavioral Health, please visit www.acbhcs.org.

THE POSITION

Under general supervision, to review, evaluate,edit and process claims for payment for Behavioral Health Care ServicesProviders; to verify eligibility for a variety of insurance plans/programs,determine the primary payor and establish payment authorization based onprogram requirements; and to perform other related duties as assigned.

These positions are located in the BehavioralHealth Care Services, Claims Processing Center and report to the Health CareClaims Manager. Health Care Claims Examiners process a variety of providerclaims for services rendered to beneficiaries of Alameda County Medi-Calprogram, CalWORKS program, Child and Family Services program, Healthy Familiesprogram and Indigent Children program, and other benefit plans forPsychological services.

Health Care Claims Examiner II is thejourney-level class in the Health Care Claims Examiner series. Under minimalsupervision, incumbents perform duties of a complex and technical nature inprocessing claims requiring in-depth knowledge of appropriate insurance benefitplans, program regulations, payment or denial practices, policies andprocedures, and contract interpretation. This class is further distinguishedfrom the next higher class of Health Care Claims Manager, in that the latterclass has supervisory responsibilities and manages the activities of the ClaimsProcessing Center.

THE IDEAL CANDIDATE

In addition to meeting theminimum qualifications and knowledge and skills below, the ideal candidate willbe:

• Aquality-orientedindividual who accomplishes tasks by being attentive to details and who understands the importance of checking processes and tasks over time in order to minimize consequence of errors.
• Someone who isanalytical, resourceful, and skilled at gathering and synthesizing informationfrom a variety of stakeholders and sources in an objective, unbiased manner to reach a conclusion.
• Acompetent decision makercapable of taking action consistent with all available facts, constraints, and probable consequences in a fast-paced environment by identifying and understanding issues, problems, and opportunities, and comparing data from different sources to draw conclusions.
• Aneffective communicatorwho conveys information and in a manner that meets audience needs; someone able to develop and maintaineffective relationshipswith others and who relates well to people of diverse cultures, interpersonal styles, abilities, motivations, or backgrounds even in times of conflict.
• Someone who is agile and capable of smoothly and quicklyadapting to change, is open to different perspectives, and who adjusts effectively to work within new work structures, processes, requirements, or cultures.
• An experiencedhealth care claims professionalwho keeps up with terminology and current developments and trends in health care claims processing and who has achieved sufficient technical skill and/or knowledge in order to process claim payments and verify eligibility for a variety of insurance plans/programs.
• Someone who iswell organizedand able toplan and coordinate work activities, successfully managing several tasks at once to ensure that work is completed efficiently.
• Someone who is able to handle all work matters in a highlyconfidential, objective and professional manner.

For a detailed listing of the essential responsibilities and corecompetency requirements for this position, pleaseclick herefor the jobdescription.

The minimum professionalrequirements for admission to the competitive assessment process include:

Either

Experience: The equivalent of six monthsof full-time satisfactory experience in the Health Care Claims Examiner I orhigher classification in the Alameda County classified service.

Or II

The equivalent of two years full-time experiencein reviewing, evaluating, editing and processing claims for payment, anddetermining eligibility for a variety of insurance plans/programs in a healthcare environment.

NOTE: The CivilService Commission may modify the Minimum Qualifications in the announcement ofthe examination.

NOTE: The level and scope of the following knowledge and abilities are related to duties listed under the "Examples of Duties" section of this specification.

The most suitably qualifiedcandidates will possess the following competencies:

Knowledge of:

• Parameters of the provider’s contract obligations.
• Current policies and requirements for an array of administered insurance plans (e.g. Medi-Cal, Healthy Families, and Children’s Indigent Plan) and other regulations as they relate to insurance benefit plan/program eligibility.
• Basic policies and operations of health care insurance plans.
• Federal, State and local rules and regulations as they relate to claims processing.
• Modern office practices and procedures.
• Business mathematical computation.
• Computer application related to the work.

Ability to:

• Comprehend, interpret and follow complex instructions related to various insurance benefit programs and plans.
• Verify appropriate eligibility for a variety of insurance plans/programs.
• Exercise interpersonal sensitivity to establish and maintain effective working relationships with staff, clients, other agencies, and the public.
• Exercise independent judgment.
• Analyze, evaluate and draw logical conclusions.
• Maintain confidentiality.
• Plan and organize work.
• Prioritize work and coordinate multiple activities to meet critical deadlines.
• Perform accurate mathematical calculations.
• Communicate effectively orally and in writing.
• Understand and follow complex oral and written instructions.
• Work independently and adapt to change.
• Input accurate data into various computer systems and software programs.

THE EXAMINATION WILLCONSIST OF THE FOLLOWING STEPS:

1. A review of applicants' applications to verify possession of minimum requirements. Those applicants who possess the minimum requirements for the class will move on to the next step in the examination process.
2. An oral interview examination which will be weighted as 100 % of the candidate's final examination score. The oral interview examination may contain situational exercises.

CANDIDATESMUST ATTAIN A QUALIFYING RATING ON EACH PORTION OF THIS EXAMINATION.

Wereserve the right to make changes to the announced examination components.

Alameda County utilizes aCivil Service Selection System founded on merit. Such a system is competitiveand based on broad recruitment efforts and equal opportunity for qualifiedapplicants to test in an examination process designed to determine thequalifications, fitness, and ability of competitors to perform the duties ofthe vacant position. Many of our recruitments are targeted and specificto the needs of a current vacant position, in which case, the eligible list maybe exclusively used for that current vacant position. Other recruitments may bemore broadly used for both current and future vacancies or for other alternatejobs with comparable scopes of work.

To learn more about ourrecruitment and selection process, please visit the “What You Need to Know”section of our website,www.acgov.org/hrs.

Applicants will be informed via email with reasonablenotice in advance of any examination process which will require theirattendance. The following dates aretentativeand subject to change based on the needs of theAgency.

WE RESERVE THE RIGHT TO MAKECHANGES TO THE ANNOUNCED RECRUITMENT & SELECTION PLAN

Alameda County and the Human Resource Services Department will make reasonableefforts in the examination and/or selection process to accommodate qualifiedindividuals with disabilities and/or medical conditions inaccordance/compliance with the State Fair Employment and Housing Act (FEHA),Federal Americans with Disabilities Act (ADA) Alameda County’s ReasonableAccommodation Policy and applicable statutes. To request accommodation due to adisability/medical condition during this or other phases of the examination/selectionprocess, please contact the assigned Human Resources Representative listed onthe job announcementbefore the last date of filing.Alameda County requires applicants to provide supporting documentation tosubstantiate a request for reasonable accommodation. In order to qualify for areasonable accommodation, applicants must have a disability/medical conditionpursuant to the ADA, FEHA and applicable statutes.

For more information regarding our Reasonable Accommodationprocedures, please visit our website,www.acgov.org/hrs.

Alameda County offers a comprehensive and competitive benefits package that affords wide-ranging health care options to meet the different needs of a diverse workforce and their families. We also sponsor many different employee discount, fitness and health screening programs focused on overall well being. These benefits include but are not limited to*:

For your Health & Well-Being

• Medical – HMO & PPO Plans
• Dental – HMO & PPO Plans
• Vision or Vision Reimbursem*nt
• Share the Savings
• Basic Life Insurance
• Supplemental Life Insurance (with optional dependent coverage for eligible employees)
• County Allowance Credit
• Flexible Spending Accounts - Health FSA, Dependent Care and Adoption Assistance
• Short-Term Disability Insurance
• Long-Term Disability Insurance
• Voluntary Benefits - Accident Insurance, Critical Illness, Hospital Indemnity and Legal Services
• Employee Assistance Program

For your Financial Future

• Retirement Plan - (Defined Benefit Pension Plan)
• Deferred Compensation Plan (457 Plan or Roth Plan)

For your Work/Life Balance

• 12 paid holidays
• Floating Holidays
• Vacation and sick leave accrual
• Vacation purchase program
• Catastrophic Sick Leave
• Pet Insurance
• Commuter Benefits Program
• Guaranteed Ride Home
• Employee Wellness Program (e.g. At Work Fitness, Incentive Based Programs, Gym Membership Discounts)
• Employee Discount Program (e.g. theme parks, cell phone, etc.)
• Child Care Resources
• 1^st United Services Credit Union

*Eligibility is determined by Alameda County and offerings may vary by collective bargaining agreement. This provides a brief summary of the benefits offered and can be subject to change.

All notices relatedto County recruitments for which you have applied will be sent/delivered viaemail. Please add @jobaps.com, @acgov.org, nonreplyalamedacountyhr@acgov.org, and Noreply@jobaps.com as accepted addresses to any email blocking or spamfiltering program you may use. If you do not do this, your email blocking orspam filtering program may block receipt of the notices regarding yourapplication for recruitments. You are also strongly advised to regularly loginto your County of Alameda online application account to check for noticesthat may have been sent to you. All email notices that will be sent to you willalso be kept in your personal online application account. You will be able to viewall of your notices in your online application account by clicking on the"My applications" button on the Current Job Openings page.

Please take the steps recommended above to ensure you donot miss any notices about a recruitment for which you have applied. The Countyof Alameda is not responsible for notices that are not read, received oraccessed by any applicant for a County recruitment.

NOTE: All notices are generated through an automatedemail notification system. Replies to the email boxes Noreply@jobaps.com and nonreplyalamedacountyhr@acgov.org, are routed to unmonitored mailboxes. If you havequestions, please go to our website at www.acgov.org/hrs. You may also contact the Human Resources Analyst listedon the job announcement for the recruitment for which you have applied.

Nicole Lewis-Bolton,Human Resources Analyst

HumanResource Services, County of Alameda

(510)272-6468 • nicole.lewis-bolton@acgov.org

https://hrs.alamedacountyca.gov

Disaster ServiceWorker

All Alameda County employees aredesignated Disaster Service Workers through state and local law. Employmentwith the County requires the affirmation of a loyalty oath to thiseffect. Employees are required to report to work as ordered in the eventof an emergency.

Equal EmploymentOpportunity

Alameda County has adiverse workforce, that is representative of the communities we serve, and isproud to be an equal opportunity employer. All aspects of employment are basedon merit, competence, performance and business need. Alameda County does notdiscriminate in employment on the basis of: race, color, religion, sex(including pregnancy and gender identity), national origin, politicalaffiliation, sexual orientation, marital status, disability, geneticinformation, age, membership in an employee organization, retaliation, parentalstatus, military service, or other non-merit factors protected under federal,state and local law. Alameda County celebrates diversity and is committed tocreating an inclusive, and welcoming workplace environment.