DCHBX Social Justice Values Statement
We believe in social justice and the power of diversity, equity, and inclusion and are committed to fighting longstanding discrimination, racial injustice, and systemic racism to contribute to a more just and equitable future for our workforce, our customers, and our partners.
Introduction
This position is in the District of Columbia Health Benefit Exchange Authority (DCHBX). The mission of the Health Benefit Exchange Authority is to implement a health care exchange program in the District of Columbia in accordance with the Patient Protection and Affordable Care Act (PPACA) of 2010 and the District of Columbia Health Benefit Exchange Authority Establishment Act of 2011, thereby ensuring access to quality and affordable health care to all District of Columbia residents.
The incumbent in this position works with HBX carrier partners and directs and supervises the work of electronic data interchange (EDI) staff. EDI includes 834 files, maintenance files, error logs, 820 files, and effectuation files. The incumbent also works with the federal government on required data files submitted to the Center for Medicare and Medicaid Services (CMS), Internal Revenue Service, and other federal agencies for identity proofing; verification of tax credit eligibility; validation of insurance enrollment, including Medicaid and/or private insurance programs. Also works closely with internal staff, including policy and business staff, contact center staff, and command and control center staff. The position ensures that individuals, families, and businesses are properly enrolled in qualified health plans and qualified dental plans.
POSITION CONTROLS
The incumbent works under the administrative supervision of the Director for Programs and Operations, HBX, which makes assignments in terms of broadly defined missions and functions. The Director for Programs and Operations relies on the incumbent's expertise for independent performance and judgment of work to be accomplished. The incumbent discusses matters of a policy nature with the Director for Programs and Operations recommends major changes in policies and program activities. Results of the work are considered technically authoritative and are normally accepted without significant change. If the work should be reviewed, the review concerns such as the accomplishment of goals within broad guidelines established by the Director for Programs and Operations, and in compliance with internal operating and administrative policies and procedures.
Major Duties And Responsibilities
Supervises and directs the work of EDI program analysts and other EDI team members, including consultants that may be retained during peak enrollment periods. Provides training and acts in a mentor capacity to EDI junior team members. Sets the overall objectives and resources available to the staff, and develops the deadlines, projects, and work to be completed. Coaches and motivates staff professionals to excel in creating positive solutions to improve service delivery. Works to build and sustain best practices in all administrative areas.
Works with insurance companies to resolve business issues based on electronic data exchanged between HBX, insurers, and various federal agencies. This includes initial enrollment in a qualified plan, changes to enrollment, including new dependents, and disenrollment. Identifies and researches EDI issues and develops and implements work plans to address the issues. Guides team members on how to correct issues with 834s and other EDI files used to transmit information to health insurance carriers, including facilitating manual correction, when necessary, for each 834 not accepted electronically by insurers.
Manually produce EDI files for cases requiring a manual 834. Provides support for EDI software development activities. Work with federal agencies on issues related to 834 and other data file transfers to the federal government. Participates in all phases of testing software and data transfer testing. Thoroughly documents EDI transactions and data issues, if any, and their resolution.
Qualifications And Education
Specialized Experience
– Experience that equipped the applicant with the particular knowledge, skills, and abilities to perform successfully the duties of the position, and this is typically in or related to the work of the position to be filled. To be creditable, at least one (1) year of specialized experience must have been equivalent to at least the next lower grade level in the normal line of progression for the occupation in the organization.
Licenses and Certifications
None
Working Conditions/Environment
Work is generally performed in an office setting.
Promotion Potential
No known promotion potential.
Other Significant Facts
Tour of Duty: Monday -
Friday 8:15 a.m.- 4:45 p.m.
Pay Plan, Series, Grade:
MS-0301-14
Collective Bargaining Unit:
This position is not a part of a collective bargaining unit.
Duration of Appointment:
MSS At-Will. Positions in the Management Supervisory Service (MSS) serve at the pleasure of the appointing authority and may be terminated at any time with or without cause.
Position Destination:
This position has been deemed Security Sensitive under the guidelines of the DC Personnel Manual. Incumbents of this position are subject to enhanced suitability screening pursuant to Chapter 4 of DC personnel regulations. Accordingly, incumbents must successfully pass a criminal background and consumer credit check as a condition of employment and will be subject to periodic criminal background checks for the duration of their tenure.
EEO Statement:
The District of Columbia Government is an Equal Opportunity Employer. All qualified candidates will receive consideration without regard to race, color, religion, national origin, sex, age, marital status, personal appearance, sexual orientation, family responsibilities, matriculation, physical handicap, or political affiliation.