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HIPP Operations Specialist

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HIPP Operations Specialist

Salary

$50,836.00 - $77,321.00 Annually

Location

Warren County, PA

Job Type

Civil Service Permanent Full-Time

Job Number

CS-2025-25040-49230

Department

Department of Human Services

Division

HS Div Third Prty Liab

Opening Date

05/08/2025

Closing Date

5/22/2025 11:59 PM Eastern

Job Code

49230

Position Number

00209198

Union

AFSCME

Bargaining Unit

A4

Pay Group

ST06

Bureau / Division Code

00211793

Worksite Address

Warren State Hospital

Worksite Address

589 Hospital Drive, Suite D

City

Warren, Pennsylvania

Zip Code

16365

Contact Name

Ricki Paden

Contact Email

[email protected]

Bureau / Division

Bureau of Program Integrity / Division of Third Party Liabilty / Health Insurance Premium Payment Program

+ Description

+ Benefits

+ Questions

THE POSITION

Are you a resourceful problem-solver who excels in fast-paced environments? The Department of Human Services’ Health Insurance Premium Payment (HIPP) program is seeking a dedicated HIPP Operations Specialist to support medical assistance recipients enrolling in employer-sponsored health insurance. In this key role, you will assess cost-effectiveness and facilitate the enrollment of eligible applicants into the HIPP program. This is an outstanding opportunity to grow your career while making a meaningful impact on operational efficiency and providing valuable support across departments.

DESCRIPTION OF WORK

In this position, you will evaluate and analyze employer-sponsored group health insurance to assess eligibility and determine the cost-effectiveness of the coverage offered through the HIPP program. You will respond to client inquiries, providing accurate information based on medical assistance eligibility, employment status, and benefit details. Your responsibilities will include reviewing policy benefits and deductibles to assess the suitability of the policy for HIPP enrollment. Additionally, you will address issues related to the accurate posting of HIPP resources in the eligibility database. You will also respond to caseworker requests to verify credible coverage, in accordance with HIPAA regulations. Strong organizational and prioritization skills will be essential in managing these duties. This role involves both written and verbal communication with Medicaid recipients, providers, employers, and various agencies.

Interested in learning more? Additional details regarding this position can be found in the position description (https://careers.employment.pa.gov/pd/PD\_NEOGOV.asp?p=00209198) .

Work Schedule and Additional Information:

+ Full-time employment, 37.5 hours per week

+ Work hours are 8:00 AM to 4:00 PM, Monday - Friday, with a 30-minute lunch.

+ Free Parking!

+ Telework: You may have the opportunity to work from home (telework) part-time up to 3 days per week. In order to telework, you must have a securely configured high-speed internet connection and work from an approved location inside Pennsylvania. If you are unable to telework, you will have the option to report to the headquarters office in Warren.

+ Salary: In some cases, the starting salary may be non-negotiable.

+ You will receive further communication regarding this position via email. Check your email, including spam/junk folders, for these notices.

REQUIRED EXPERIENCE, TRAINING & ELIGIBILITY

QUALIFICATIONS

Minimum Experience and Training Requirements:

+ One year of experience as a Third Party Liability or Medical Assistance Program Technician (Commonwealth job title or equivalent Federal Government job title, as determined by the Office of Administration);or

+ Four years of experience in the review and analysis of medical insurance policies and premiums, reviewing and responding to inquiries relating to applicable service or benefits in health care insurance programs, health care services or Medical Assistance program services;or

+ Any equivalent combination of experience and training.

Other Requirements:

+ You must meet the PA residency requirement (https://www.employment.pa.gov/Additional%20Info/Pages/default.aspx) . For more information on ways to meet PA residency requirements, follow thelink (https://www.employment.pa.gov/Additional%20Info/Pages/default.aspx) and click on Residency.

+ You must be able to perform essential job functions.

How to Apply:

+ Resumes, cover letters, and similar documents willnotbe reviewed, and the information contained therein will not be considered for the purposes of determining your eligibility for the position. Information to support your eligibility for the position must be provided on the application (i.e., relevant, detailed experience/education).

+ If you are claiming education in your answers to the supplemental application questions, you must attach a copy of your college transcripts for your claim to be accepted toward meeting the minimum requirements. Unofficial transcripts are acceptable.

+ Your application must be submitted by the posting closing date. Late applications and other required materials will not be accepted.

+ Failure to comply with the above application requirements may eliminate you from consideration for this position.

Veterans:

+ Pennsylvania law (51 Pa. C.S. §7103) provides employment preference for qualified veterans for appointment to many state and local government jobs. To learn more about employment preferences for veterans, go to www.employment.pa.gov/Additional%20Info/Pages/default.aspx and click the Veterans’ Preference tab or contact us at [email protected] .

Telecommunications Relay Service (TRS):

+ 711 (hearing and speech disabilities or other individuals).

If you are contacted for an interview and need accommodations due to a disability, please discuss your request for accommodations with the interviewer in advance of your interview date.

The Commonwealth is an equal employment opportunity employer and is committed to a diverse workforce. The Commonwealth values inclusion as we seek to recruit, develop, and retain the most qualified people to serve the citizens of Pennsylvania. The Commonwealth does not discriminate on the basis of race, color, religious creed, ancestry, union membership, age, gender, sexual orientation, gender identity or expression, national origin, AIDS or HIV status, disability, or any other categories protected by applicable federal or state law. All diverse candidates are encouraged to apply.

EXAMINATION INFORMATION

+ Completing the application, including all supplemental questions, serves as your exam for this position. No additional exam is required at a test center (also referred to as a written exam).

+ Your score is based on the detailed information you provide on your application and in response to the supplemental questions.

+ Your score is valid for this specific posting only.

+ You must provide complete and accurate information or:

+ your score may be lower than deserved.

+ you may be disqualified.

+ You may only apply/testoncefor this posting.

+ Your results will be provided via email.

Learn more about our Total Rewards by watching this shortvideo (https://www.youtube.com/embed/HtcSRnndflc?rel=0) !

See the total value of your benefits package by exploring ourbenefits calculator.

Health & Wellness

We offer multiple health plans so our employees can choose what works best for themselves and their families. Our comprehensive benefits package includes health coverage, vision, dental, and wellness programs.*

Compensation & Financial Planning

We invest in our employees by providing competitive wages and encouraging financial wellness by offering multiple ways to save money and ensure peace of mind including multiple retirement and investment plan options.

Work/Life Balance

We know there’s more to life than just work! Our generous paid leave benefits include paid vacation, paid sick leave, eight weeks of paid parental leave, military leave, and paid time off for most major U.S. holidays, as well as flexible work schedules and work-from-home opportunities.*

Values and Culture

We believe in the work we do and provide continual opportunities for our employees to grow and contribute to the greater good. As one of the largest employers in the state, we provide opportunities for internal mobility, professional development, and the opportunity to give back by participating in workplace charitable giving.

Employee Perks

Sometimes, it is the little “extras” that make a big difference. Our employees receive special employee-only discounts and rates on a variety of services and memberships.

For more information on all of these Total Rewards benefits, please visitwww.employment.pa.gov and click on the benefits box.

*Eligibility rules apply.

01

Have you been employed by the Commonwealth of Pennsylvania as a Third Party Liability Program Technician for one or more years full-time?

+ Yes

+ No

02

If you are claiming experience in the above question, please list the employer(s) where you gained this experience in the text box below. The employer(s) and a description of the experience must also be included in the appropriate sections of your application if you would like the experience to be considered in the eligibility decision. If you claimed you do not have experience, type N/A in the text box below.

03

Have you been employed by the Commonwealth of Pennsylvania as a Medical Assistance Program Technician for one or more years full-time?

+ Yes

+ No

04

If you are claiming experience in the above question, please list the employer(s) where you gained this experience in the text box below. The employer(s) and a description of the experience must also be included in the appropriate sections of your application if you would like the experience to be considered in the eligibility decision. If you claimed you do not have experience, type N/A in the text box below.

05

How many years of experience in the review and analysis of medical insurance policies and premiums, reviewing and responding to inquiries relating to applicable service or benefits in health care insurance programs, health care services or Medical Assistance program services do you possess?

+ 4 years or more

+ 3 but less than 4 years

+ 2 but less than 3 years

+ 1 but less than 2 years

+ Less than 1 year

+ None

06

If you are claiming experience in the above question, please list the employer(s) where you gained this experience in the text box below. The employer(s) and a description of the experience must also be included in the appropriate sections of your application if you would like the experience to be considered in the eligibility decision. If you claimed you do not have experience, type N/A in the text box below.

07

How much college coursework have you completed in a health care service field?

If you are claiming credits/degree, you must upload a copy of your college transcript(s) for this education to be considered in the eligibility decision. Unofficial transcripts are acceptable. You must attach your transcript(s) prior to the submission of your application by using the "Attachments" tab on the left. You will not be able to add a transcript(s) to the application after it has been submitted.

If your education was acquired outside of the United States, you must upload a copy of your foreign credential evaluation report. We can only accept foreign credential evaluations from organizations that are members of the National Association of Credential Services (NACES). A list of current NACES members can be found by visiting visitingwww.naces.organd clicking the Evaluation Services Link.

For additional information on foreign education credentials, please visithttps://www.employment.pa.gov/Additional%20Info/Pages/default.aspx#q3and click on Other Information. You must attach your documentation prior to the submission of your application by using the "Attachments" tab on the left. You will not be able to add a document to the application after it has been submitted.

+ Conferred Bachelor's degree or higher

+ Conferred Associate's degree

+ Some coursework but no degree

+ None

08

Have you completed any post-high school health care service training?

+ Yes

+ No

09

If you indicated you have completed post-high school health care service training, please provide your responses to the items listed below. If you indicated you have no training related to this work behavior, type N/A in the text box below.

+ Training Source

+ Course Title

+ Credits/Clock Hours

10

You must complete the supplemental questions below. These supplemental questions are the exam and will be scored. They are designed to give you the opportunity to relate your experience and training background to the major activities (Work Behaviors) performed in this position. Failure to provide complete and accurate information may delay the processing of your application, or result in a lower-than-deserved score or disqualification. Youmustcomplete the applicationandanswer the supplemental questions. Resumes, cover letters, and similar documents will not be reviewed for the purposes of determining your eligibility for the position or to determine your score.

All information you provide on your application and supplemental questions is subject to verification. Any misrepresentation, falsification or omission of material facts is subject to penalty. If requested, you must provide documentation, including names, addresses, and telephone numbers of individuals who can verify the validity of the information you provide in the application and supplemental questions.

Read each work behavior carefully. Determine and select which "Level of Performance" most closely represents your highest level of experience/training. List the employer(s)/training source(s) from your Work or Education sections of the application where you gained this experience/training.The "Level of Performance" you choose for each work behavior must be clearly supported within the description of the experience and training information entered in your application or your score may be lowered.In order to receive credit for experience, you must have worked in a job for at least six months in which the experience claimed was a major function.

If you have read and understand these instructions, please click on the "Yes" button and proceed to the exam questions.

If you have general questions regarding the application and hiring process, please refer to ourFAQ page (https://www.employment.pa.gov/Additional%20Info/Pages/default.aspx) .

+ Yes

11

WORK BEHAVIOR 1 – REVIEWING HEALTH INSURANCE POLICIES AND COVERAGE

Review referrals of eligible Medical Assistance (MA) recipients for enrollment into Employer Group Health Program (EGHP); Analyze and compare insurance premiums for specific coverage against projected annual MA expenditures to evaluate EGHP policies and employee benefit plan summaries; Determine cost effectiveness of EGHP cost versus medical assistance expenditure; Make enrollment and payment arrangements with recipients.

Levels of Performance

Select the "Level of Performance" which best describes your claim.

+ A. I have experience reviewing recipients' eligibility for enrollment into health insurance, analyzing and comparing insurance policies for specific coverages OR processing enrollment and making payment arrangements with recipients.

+ B. I have experience processing medical claims OR reviewing Medical Assistance referrals.

+ C. I have successfully completed college-level coursework related to healthcare benefits.

+ D. I have NO experience or training related to this work behavior.

12

In the text box below, please describe your experience as it relates to the level of performance you claimed in this work behavior. Please be sure your response addresses the items listed below which relate to your claim. If you indicated you have no work experience related to this work behavior, type N/A in the box below.

+ The name of the employer(s) where you gained this experience

+ Describe the experience you are claiming related to health insurance policies and coverages

+ The actual duties you performed

13

If you have selected the level of performance pertaining to college coursework, please provide your responses to the items listed below. If you indicated you have no education/training related to this work behavior, type N/A in the text box below.

+ College/University

+ Course Title

+ Credits/Clock Hours

14

WORK BEHAVIOR 2 – EDUCATE AND EXPLAIN ADMINISTRATIVE PROCESSES

Educate and explain the various laws, rules, regulations, policies, and procedures of the Health Insurance Premium Payment Program (HIPP) to employers, providers, caseworkers and clients by referring to HIPP Procedure Manual, bulletins, related updates, and knowledgeable individuals. Explain the administrative processes and procedures for participation in the HIPP to include the enrollment process, the cost effectiveness determination process, and the premium payment process.

Levels of Performance

Select the "Level of Performance" which best describes your claim.

+ A. I have experience educating and explaining the various laws, rules, regulations, policies, or procedures of health insurance to employers, providers, caseworkers or clients by referring to procedure manuals, bulletins, related updates and speaking with knowledgeable individuals.

+ B. I have experience explaining policies and procedures to various interested parties as a function of my job.

+ C. I have successfully completed college-level coursework related to communications or public speaking.

+ D. I have NO experience or training related to this work behavior.

15

In the text box below, please describe your experience as it relates to the level of performance you claimed in this work behavior. Please be sure your response addresses the items listed below which relate to your claim. If you indicated you have no work experience related to this work behavior, type N/A in the box below.

+ The name of the employer(s) where you gained this experience

+ Describe the type of policies, procedures, etc. that you explain

+ The actual duties you performed

16

If you have selected the level of performance pertaining to college coursework, please provide your responses to the items listed below. If you indicated you have no education/training related to this work behavior, type N/A in the text box below.

+ College/University

+ Course Title

+ Credits/Clock Hours

17

WORK BEHAVIOR 3 – ENROLL, MAINTAIN AND DISCONTINUE CASES

Enroll, maintain, and discontinue HIPP cases by responding to inquiries by e-mail, telephone, fax, and in written form from various entities such as County Assistance Offices, employers, insurance carriers, clients, etc. Contact health care providers to determine diagnoses; negotiate with employers, insurance carriers, and/or COBRA administrators to make payment arrangements. Respond to information obtained from change report forms and phone calls; report provider issues and client care issues to proper agencies; develop and document detailed records for maintenance and for cases deemed no longer eligible.

Levels of Performance

Select the "Level of Performance" which best describes your claim.

+ A. I have experience in caseload management by enrolling and discontinuing cases by responding to inquiries through e-mail, by telephone, fax, and in written form from various entities such as offices, employers, insurance carriers, clients, etc.

+ B. I have experience assisting with caseload management by verifying information and updating associated case files.

+ C. I have successfully completed college-level coursework related to case management.

+ D. I have NO experience or training related to this work behavior.

18

In the text box below, please describe your experience as it relates to the level of performance you claimed in this work behavior. Please be sure your response addresses the items listed below which relate to your claim. If you indicated you have no work experience related to this work behavior, type N/A in the box below.

+ The name of the employer(s) where you gained this experience

+ The experience you have with enrolling, maintaining or discontinuing cases

+ The actual duties you performed

19

If you have selected the level of performance pertaining to college coursework, please provide your responses to the items listed below. If you indicated you have no education/training related to this work behavior, type N/A in the text box below.

+ College/University

+ Course Title

+ Credits/Clock Hours

20

WORK BEHAVIOR 4 – TRACK AND MAINTAIN DOCUMENTATION

Utilize computer and related software such as Medical Assistance for Workers With Disabilities (MAWD) System, HIPP System, HIPP Fiscal and Client Information System (CIS), etc. to enter, maintain, discontinue, and document cases by accessing proper system files consisting of client and enrollment information, employer benefits, HIPP payment history data, savings history data, and Cost Effectiveness Worksheet; perform scheduled re-evaluations for continued cost effectiveness, calculate overpayments and supplements, adjudicate returned checks and resolve HIPP status code reports.

Levels of Performance

Select the "Level of Performance" which best describes your claim.

+ A. I have experience utilizing computer software to enter, maintain, and discontinue cases.

+ B. I have experience utilizing computer software to track and document work.

+ C. I have successfully completed college-level coursework related to database management or introduction to computing.

+ D. I have NO experience or training related to this work behavior.

21

In the text box below, please describe your experience as it relates to the level of performance you claimed in this work behavior. Please be sure your response addresses the items listed below which relate to your claim. If you indicated you have no work experience related to this work behavior, type N/A in the box below.

+ The name of the employer(s) where you gained this experience

+ The type of work you tracked utilizing software

+ The actual duties you performed

+ Your level of responsibility

22

If you have selected the level of performance pertaining to college coursework, please provide your responses to the items listed below. If you indicated you have no education/training related to this work behavior, type N/A in the text box below.

+ College/University

+ Course Title

+ Credits/Clock Hours

Required Question

Employer

Commonwealth of Pennsylvania

Address

613 North Street

Harrisburg, Pennsylvania, 17120

Website

http://www.employment.pa.gov