Accountant/Examiner 3 (PN 20014051)

What You'll Do:

The Complex Medical Help (CMH) program is seeking a detail-oriented professional to support healthcare program operations by analyzing claims, ensuring compliance and improving processes that impact clients and providers. Duties include:

• Review and audit daily financial and claims transactions for accuracy and compliance.
• Authorize payments and ensure propers coding within applicable systems.
• Analyze claimant data, billing, and expenses to ensure completeness and eligibility.
• Monitor pharmacy benefit operations and ensure compliance with state and federal regulations.
• Administer pharmacy benefits, including eligibility and co-pay determinations.
• Investigate claims and rejections and recommend process improvements.
• Review payment records, claims data, and third-party reports to resolve issues and support stakeholders.
• Prepare reports, summaries, and analyses to support decision-making.
• Conduct research and develop written materials on program policies and system updates.
• Collaborate with internal teams to identify and recover funds efficiently.
• Support case conferences by providing data, analysis, and system insights.

• Perform system and eligibility analysis related to third-party payers.

Unusual Working Conditions: May Require Travel

At the State of Ohio, we take care of the team that cares for Ohioans. We provide a variety of quality, competitive benefits to eligible full-time and part-time employees*. For a list of all the State of Ohio Benefits, visit our Total Rewards website! Our benefits package includes:

• Medical Coverage
• Free Dental, Vision and Basic Life Insurance premiums after completion of eligibility period
• Paid time off, including vacation, personal, sick leave and 11 paid holidays per year
• Childbirth, Adoption, and Foster Care leave
• Education and Development Opportunities (Employee Development Funds, Public Service Loan Forgiveness, and more)
• Public Retirement Systems (such as OPERS, STRS, SERS, and HPRS) & Optional Deferred Compensation (Ohio Deferred Compensation)

• Benefits eligibility is dependent on a number of factors. The Agency Contact listed above will be able to provide specific benefits information for this position.

Position Qualifications:

Completion of undergraduate core coursework in accounting or 2 yrs. exp. in accounting.

Or

Completion of undergraduate core coursework in business administration, economics, computer science or related field AND 16 semester or 24 quarter hours in accounting.

Or

12 mos. exp. as Accountant/ Examiner 2, 66112 with state government exp. commensurate with duties to be assigned.

Or

Equivalent of Minimum Class Qualifications for Employment noted above.

Additional Qualifications:

Applications of those who meet the minimum qualifications will be further evaluated against the following criteria:

• Bachelors or advanced degree in accounting, business administration, economics, computer science or related field

• Experience in pharmacy operations (e.g., prescription fulfillment, claims resolution)

• Experience working with third-party payers and coordinating benefits

• Experience working with spreadsheet software (e.g., Excel, Google Sheets)

• Experience working with medical billers/providers, case managers, and/or clients to resolve pharmacy claims billing issues.

• Experience with Accounts Payable/Receivable

All eligible applications shall be reviewed considering the following criteria: qualifications, experience, education, and active disciplinary record.

Job Skills: Accounting and Finance

Technical Skills: Auditing, Claims Examination, Compliance Enforcement

Professional Skills: Analyzation, Attention to Detail, Interpreting Data

Educational Transcript Requirements:
Official educational transcripts are required for all post-high school educational accomplishments, coursework or degrees claimed on the application. Applicants will be required to submit an official transcript prior to receiving a formal offer of employment. Failure to provide transcripts within five (5) working days of being requested will cause the applicant to be eliminated from further consideration.

Please note that a transcript is considered "official" only if it is an original copy from the educational institution and includes an institutional watermark, ink stamp or embossed stamp. Transcripts printed from the institution's website will not be accepted. ODH reserves the right to assess the academic credibility of an educational entity's award of a putative degree.

Supplemental Information:

ALL ANSWERS TO THE SUPPLEMENTAL QUESTIONS MUST BE SUPPORTED BY THE WORK EXPERIENCE/EDUCATION PROVIDED ON YOUR CIVIL SERVICE APPLICATION.
Unless required by legislation, the selected candidate will begin at Pay Grade 30, Step 1 of the OCSEA union Pay Range Schedule ($25.77 per hour), with an opportunity for pay increase after six months ($26.76) of satisfactory performance and then a yearly raise thereafter.

APPLICATION PROCEDURES:
All applicants must submit a completed Ohio Civil Service Application using the TALEO System. Paper applications will not be considered. Applicants must clearly indicate how they meet the minimum qualifications and/or position specific minimum qualifications. Applicants are also encouraged to document any experience, education and/or training related to the job duties above. An assessment of these criteria may be conducted to determine the applicants who are interviewed.

STATUS OF POSTED POSITION:
You can check the status of your application online by signing into your profile. Jobs you applied for will be listed. The application status is shown to the right of the position title and application submission details.

BACKGROUND CHECK NOTICE:
The final candidate selected for this position will be required to undergo a criminal background check. Criminal convictions do not necessarily preclude an applicant from consideration for a position. An individual assessment of an applicant's prior criminal convictions will be made before excluding an applicant from consideration.

Ohio is a Disability Inclusion State and strives to be a model employer of individuals with disabilities. The State of Ohio is committed to providing access and inclusion and reasonable accommodation in its services, activities, programs and employment opportunities in accordance with the Americans with Disabilities Act (ADA) and other applicable laws.

The State of Ohio is a drug-free workplace which prohibits the use of marijuana (recreational marijuana/non-medical cannabis). Please note, this position may be subject to additional restrictions pursuant to the State of Ohio Drug-Free Workplace Policy (HR-39), and as outlined in the posting.