Health and Human Resources Specialist - Human Services - Bureau for Medical Services - Kanawha Co.

$37,536 - $65,020/Yr

State Of West Virginia

Full-time - Entry Level

Executive, Legislative, and Other General Government Support

About the position

The Health and Human Resources Specialist position within the Bureau for Medical Services in Kanawha County is a full-time, permanent role that operates under the general supervision of the director of provider rate development. This position is crucial for ensuring that the buy-in programs are administered in compliance with both federal and state regulations. The incumbent will engage in advanced-level work, providing administrative coordination of complex regulations and technical program specifications. The current buy-in programs include premium assistance for Medicare Part A, B, and D plan coverage, private/commercial insurance plans, and oversight of the Medicaid work incentive network (m-win). These programs enable qualified individuals with disabilities to purchase Medicaid insurance coverage while maintaining employment. The responsibilities of this role include the reconciliation and accurate reporting of premium payments, ensuring that insurance coverage is correctly recorded in the claims system, and adhering to all federal timelines to guarantee benefit coverage. The specialist will maintain direct contact with various agencies, including the local West Virginia Social Security Administration office, local Department of Health and Human Resources area offices, Medicaid claims processing agents, and the Centers for Medicare and Medicaid Services. This position is essential for ensuring that the eligibility records of West Virginia Medicaid members are accurate, current, and consistent with the members' coverage status. In addition to these duties, the specialist will address procedural changes, clarify guidelines, and manage both written and verbal correspondence. They will communicate directly to resolve current eligibility and coverage issues with social security offices, the US Railroad Retirement Board, Medicaid providers, and other stakeholders. The role also involves maintaining full responsibility for applying current regulations to individual situations within the buy-in program, assisting in the review and development of regulations, standards, and procedures, and facilitating training and outreach presentations regarding the buy-in programs. Other duties may be assigned as necessary.

Responsibilities

• Administer buy-in programs in accordance with federal and state regulations.
• Provide administrative coordination of complex regulations and technical program specifications.
• Reconcile and accurately report premium payments for Medicaid members.
• Ensure insurance coverage is accurately recorded in the claims system.
• Maintain direct contact with various agencies including Social Security Administration and Medicaid claims processing agents.
• Address procedural changes and clarify guidelines for stakeholders.
• Communicate directly to resolve eligibility and coverage issues with various entities.
• Assist in the review and development of regulations, standards, and procedures.
• Facilitate training and outreach presentations regarding buy-in programs.

Requirements

• Bachelor's degree from a regionally accredited college or university.
• Two years of full-time, equivalent part-time paid or volunteer experience in a related technical or program area.
• Post-graduate education in a related field may substitute for required experience on a year-for-year basis.
• Master's degree in social work from a regionally accredited program may also qualify.

Nice-to-haves

• Experience in health and human resources programs.
• Knowledge of Medicaid and Medicare regulations.
• Strong communication and interpersonal skills.

Benefits

• Health insurance coverage.
• Paid holidays and vacation time.
• Retirement savings plan options.