Introduction THIS IS A NEW ASSEMBLED EXAMINATION . The eligible list resulting from this examination will cancel any existing list and may last approximately one year but can be extended.
Applications must be in the possession of the Human Resource Services Department by 5:00 p.m. on the Last Day for Filing.
Applications will only be accepted online. DESCRIPTION THECOUNTY Alameda County, located on the east side of San Francisco Bay, is California's seventh-largest county. The County employs 9,700 full-time employees and operates on an annual budget of $3.4 billion. Oakland, the County seat, is California's eighth-largest city. One and a half million people call 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 is a blend of culturally and ethnically diverse communities, and its mixture of cosmopolitan and suburban areas provides the perfect environment for families and their active lifestyles. The County offers extensive cultural resources, countless recreational opportunities, and an array of fine public and private colleges and universities.
ALAMEDA COUNTY HEALTH Alameda County Health is the local government agency that promotes and protects the health and well-being of all who live, work, learn, and play in Alameda County. We coordinate services and cultivate partnerships with community organizations and providers to help ensure access, organize, and deliver health care and services to people with Medi-Cal and without insurance, support resilient communities, and improve health for all. We focus on health equity by developing programs and systemic solutions that reduce disparities for the people and communities we serve.
Alameda County Health’s departments and programs focus on services 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.
BEHAVIORAL HEALTH DEPARTMENT As part of Alameda County Health, the Behavioral Health Department supports people with Medi-Cal and without insurance living with serious mental illness and substance use conditions along their path toward wellness, recovery, and resiliency. We provide services through a network of contracted mental health and substance use providers and administer the State’s resources and training for behavioral health providers, case managers, and other healthcare professionals. We advocate for our patients and families and create space for personal engagement in their care.
We are outpatient specialists for mental health services for older adults and youth, substance use providers and treatment program specialists, advocates for quality improvement and patients’ rights, and psychiatric and integrated health care 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 Services Providers; to verify eligibility for a variety of insurance plans/programs, determine the primary payor and establish payment authorization based on program requirements; and to perform other related duties as assigned.
These positions are located in the Behavioral Health Care Services, Claims Processing Center and report to the Health Care Claims Manager. Health Care Claims Examiners process a variety of provider claims for services rendered to beneficiaries of Alameda County Medi-Cal program, CalWORKS program, Child and Family Services program, Healthy Families program and Indigent Children program, and other benefit plans for Psychological services.
Health Care Claims Examiner II is the journey-level class in the Health Care Claims Examiner series. Under minimal supervision, incumbents perform duties of a complex and technical nature in processing claims requiring in-depth knowledge of appropriate insurance benefit plans, program regulations, payment or denial practices, policies and procedures, and contract interpretation. This class is further distinguished from the next higher class of Health Care Claims Manager, in that the latter class has supervisory responsibilities and manages the activities of the Claims Processing Center.
THE IDEAL CANDIDATE In addition to meeting the minimum qualifications and knowledge and skills below, the ideal candidate will be:
- 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 is analytical, resourceful, and skilled at gathering and synthesizing information from a variety of stakeholders and sources in an objective, unbiased manner to reach a conclusion.
- A competent decision maker capable 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.
- An effective communicator who 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 quickly adapting to change , is open to different perspectives, and who adjusts effectively to work within new work structures, processes, requirements, or cultures.
- An experienced health care claims professional who 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 is well organized and 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 highly confidential , objective and professional manner.
For a detailed listing of the essential responsibilities and core competency requirements for this position, please
click here for the job description.
MINIMUM QUALIFICATIONS The minimum professional requirements for admission to the competitive assessment process include :
Either Experience: The equivalent of six months of full-time satisfactory experience in the Health Care Claims Examiner I or higher classification in the Alameda County classified service.
Or II The equivalent of two years full-time experience in reviewing, evaluating, editing and processing claims for payment, and determining eligibility for a variety of insurance plans/programs in a health care environment.
NOTE : The Civil Service Commission may modify the Minimum Qualifications in the announcement of the examination.
KNOWLEDGE AND SKILLSNOTE: 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 qualified candidates 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.
EXAMINATION COMPONENTS THE EXAMINATION WILL CONSIST OF THE FOLLOWING STEPS: 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. 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.
CANDIDATES MUST ATTAIN A QUALIFYING RATING ON EACH PORTION OF THIS EXAMINATION. We reserve the right to make changes to the announced examination components.
Alameda County utilizes a Civil Service Selection System founded on merit. Such a system is competitive and based on broad recruitment efforts and equal opportunity for qualified applicants to test in an examination process designed to determine the qualifications, fitness, and ability of competitors to perform the duties of the vacant position. Many of our recruitments are targeted and specific to the needs of a current vacant position, in which case, the eligible list may be exclusively used for that current vacant position. Other recruitments may be more broadly used for both current and future vacancies or for other alternate jobs with comparable scopes of work.
To learn more about our recruitment and selection process, please visit the “What You Need to Know” section of our website,
www.acgov.org/hrs .
Selection PlanApplicants will be informed via email with reasonable notice in advance of any examination process which will require their attendance. The following dates are
tentative and subject to change based on the needs of the Agency.
TENTATIVE RECRUITMENT PLAN: Deadline for Filing: 5:00 PM, Tuesday, September 10, 2024 Review of Minimum Qualifications:
September13, 2024
Civil Service Oral Examination:
Week of September 30, 2024
Oral Examination Rating:
Week of October 14, 2024
Notification of Results:
Week of October 21, 2024
TENTATIVE SELECTION PLAN: Departmental Hiring Interviews:
November 2024
WE RESERVE THE RIGHT TO MAKE CHANGES TO THE ANNOUNCED RECRUITMENT & SELECTION PLAN Alameda County and the Human Resource Services Department will make reasonable efforts in the examination and/or selection process to accommodate qualified individuals with disabilities and/or medical conditions in accordance/compliance with the State Fair Employment and Housing Act (FEHA), Federal Americans with Disabilities Act (ADA) Alameda County’s Reasonable Accommodation Policy and applicable statutes. To request accommodation due to a disability/medical condition during this or other phases of the examination/selection process, please contact the assigned Human Resources Representative listed on the job announcement
before the last date of filing . Alameda County requires applicants to provide supporting documentation to substantiate a request for reasonable accommodation. In order to qualify for a reasonable accommodation, applicants must have a disability/medical condition pursuant to the ADA, FEHA and applicable statutes.
For more information regarding our Reasonable Accommodation procedures, please visit our website,
www.acgov.org/hrs .
BENEFITSAlameda 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 Reimbursement
- 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.
Conclusion All notices related to County recruitments for which you have applied will be sent/delivered via email. Please add @jobaps.com, @acgov.org,
nonreplyalamedacountyhr@acgov.org , and
Noreply@jobaps.com as accepted addresses to any email blocking or spam filtering program you may use. If you do not do this, your email blocking or spam filtering program may block receipt of the notices regarding your application for recruitments. You are also strongly advised to regularly log into your County of Alameda online application account to check for notices that may have been sent to you. All email notices that will be sent to you will also be kept in your personal online application account. You will be able to view all 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 do not miss any notices about a recruitment for which you have applied. The County of Alameda is not responsible for notices that are not read, received or accessed by any applicant for a County recruitment. NOTE: All notices are generated through an automated email notification system. Replies to the email boxes
Noreply@jobaps.com and
nonreplyalamedacountyhr@acgov.org , are routed to unmonitored mailboxes. If you have questions, please go to our website at
www.acgov.org/hrs . You may also contact the Human Resources Analyst listed on the job announcement for the recruitment for which you have applied.
Nicole Lewis-Bolton,Human Resources Analyst Human Resource Services, County of Alameda
(510) 272-6468 • nicole.lewis-bolton@acgov.org
https://hrs.alamedacountyca.gov
Disaster Service Worker All Alameda County employees are designated Disaster Service Workers through state and local law. Employment with the County requires the affirmation of a loyalty oath to this effect. Employees are required to report to work as ordered in the event of an emergency.
Equal Employment Opportunity Alameda County has a diverse workforce, that is representative of the communities we serve, and is proud to be an equal opportunity employer. All aspects of employment are based on merit, competence, performance and business need. Alameda County does not discriminate in employment on the basis of: race, color, religion, sex (including pregnancy and gender identity), national origin, political affiliation, sexual orientation, marital status, disability, genetic information, age, membership in an employee organization, retaliation, parental status, military service, or other non-merit factors protected under federal, state and local law. Alameda County celebrates diversity and is committed to creating an inclusive, and welcoming workplace environment.
Closing Date/Time: 9/10/2024 5:00:00 PM
