Eligibility and Coverage Services Coordinator II

Eligibility and Coverage Services Coordinator II

807 HEALTH CARE AUTHORITY

Full/Part-Time

Full time

Job Type: Regular

Compensation: $22.81875/hour

At the Oklahoma Health Care Authority (OHCA), your work matters. Every day, our team helps ensure Oklahomans have access to better health and better care. Guided by our core values, Passion for Purpose, Trust & Transparency, Empowerment & Accountability, Best-in-Class, Outcome-Driven, and Servant Leadership , we foster a workplace where people feel supported, respected, and empowered to make an impact. Learn more about OHCA.

• Generous state-paid benefit allowance to offset insurance premiums.
• A wide selection of insurance plans with no pre-existing condition exclusions.
• Flexible Spending Accounts for health care and dependent care.
• Retirement Savings Plan with employer contributions.
• 11 paid holidays annually.
• 15 days of vacation and 15 days of sick leave in the first year.
• Longevity Bonus recognizing years of public service.
• Public Service Loan Forgiveness eligibility and tuition reimbursement.
• Wellness benefits, including an on-site gym and fitness center discounts.

Location:

4345 N Lincoln Blvd, Oklahoma City, OK 73105

Salary: $22.81875/hour

Work Schedule:

Monday - Friday

Primary

Hours:

8:00 a.m.

- 5:00 p.m.

The Oklahoma Health Care Authority (OHCA) works to ensure Oklahomans have access to better health and better care. The agency's core values include passion for purpose, trust and transparency, empowerment and accountability, best in class and outcome-driven, and servant leadership. As part of the interview process, candidates may be required to attend an in-person interview at our Oklahoma City office.

The ECS Coordinator II plays a critical role in supporting the Oklahoma Health Care Authority's mission by ensuring efficient and effective administration of Sooner Care and other Medicaid programs. This position is responsible for resolving member and provider inquiries, processing claims, managing member enrollments, and maintaining compliance with program policies. The role requires strong communication skills, attention to detail, and the ability to navigate complex program guidelines, all while maintaining a high standard of service to internal and external stakeholders.

• Research and resolve provider and member inquiries, complaints, and denied claims.
• Investigate and address access to care issues, fraud, abuse, and quality assurance complaints.
• Interpret and communicate Sooner Care policies and procedures to providers, members, and stakeholders.
• Educate on program coverage, services, and eligibility guidelines for Sooner Care, BCC, DOC Inpatient, TEFRA, and Insure OK programs.
• Process and resolve electronic claims inquiries and claims reconciliation.
• Manage member applications, enrollments, plan changes, and eligibility verifications.
• Identify and report system discrepancies.
• Research and implement system updates and corrections.
• Stay current on Sooner Care rule revisions and program changes.
• Maintain organized reference materials and update written controls.
• Coordinate with other departments on referral issues and operational procedures.
• Communicate independently with members and stakeholders to resolve issues.
• Participate in special projects, member outreach, and educational efforts.
• Represent OHCA in meetings, seminars, and training forums.
• Support workflow during staff absences and manage high call volumes.
• Other duties as assigned.

The ECS Coordinator II requires in-depth knowledge of Medicaid program policies, strong communication skills for resolving inquiries, and the ability to manage complex administrative processes. This role demands attention to detail, effective collaboration, and the ability to navigate both member and provider concerns. The Korn Ferry competencies that align well with this position are Manages Complexity, for handling detailed program and policy administration, and Collaborates, for working effectively with both internal and external stakeholders to resolve issues and ensure program success.

1 year of experience in clerical office work or as a customer services representative plus 2 years of experience in customer ser