medical care program associate supervisor

4 weeks ago

Baltimore, Maryland, United States State of Maryland - MDH Med Care Prgms - Ofc of Health Services Full time

GRADE

14\r

LOCATION OF POSITION

MDH - Medicaid Provider Services Administration\r
201 W. Preston Street\r
Baltimore, MD 21201�\r

Main Purpose of Job

The main purpose of this position is to provide direct supervision to Medical Care Program Associates that are liaisons for internal and external entities both public and private regarding the Medicaid Program that provides services to long term care, acute and chronic hospitals, hospice, home health, etc., provider community and other Maryland Department of Health (MDH) administrations with matters related to claims payment. This position is the primary information resource for internal policy staff, the provider community and its fiscal representatives that make inquiries and register complaints regarding policy and procedures affecting payment of claims. This position develops, recommends, and implements Medical Care Program policies and regulations; prepares reports, identifies discrepancies in recipient eligibility, billing, pricing, and payment records for Medicaid services by making recommendations for corrective actions; interprets and applies Medicaid Program policies and regulations; consults with service providers and representatives regarding benefits and claims issues for Medical Care Programs; develops and participates in training programs related to Medicaid Program; identifies methods for cost avoidance; participates in audits, investigations and utilization review of Medicaid Program for quality assurance; makes recommendations on unusual situations regarding policy interpretation; ensuring that providers receive prompt and positive customer service by assuring that accurate information is disseminated and applied internally and externally with the interpretation of Medicaid regulations and policies regarding fee for service institutional services. Also, this position must train, direct and instruct lower-level staff and providers with applying and interpreting Medical Assistance regulations and policies. Additionally, this position must be able to exercise a significant degree of a high level of knowledge of Medicaid eligibility and billing to independently act and critically think through issues for decision-making and the ability to assist management with advising or creating standard operating procedures while communicating positively and professionally with managers, various MDH administrations, providers and vendors as well as other duties, responsibilities, and qualifications may be required and/or assigned as necessary.\r
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This position may operate in a hybrid manner, meaning job duties will be performed both remotely and onsite (e.g., 80% remote, 20% onsite), based on the designated telework schedule/plan that best fits the unit and or otherwise directed by the Appointing Authority as well as other duties, responsibilities, and qualifications may be required and/or assigned as necessary.\r

MINIMUM QUALIFICATIONS

Education:�� Graduation from an accredited high school or possession of a high school equivalency certificate. \r
Experience: Four years of clerical experience applying policies in a medical care, health insurance or federal or State entitlement program to include two years applying, interpreting and processing program specific information, policies, regulations and guidelines in a medical care program. \r
Notes:\r
1. Candidates may substitute additional general clerical experience on a year-for-year basis for the required education. \r
2. Candidates may substitute thirty credit hours from an accredited college or university for one year of the required�experience.\r

DESIRED OR PREFERRED QUALIFICATIONS

The desired candidate should possess the following:\r
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Experience with claims billing and eligibility/enrollment policies with State and federal health insurance programs.�\r
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SELECTION PROCESS

Applicants who meet the minimum (and selective) qualifications will be included in further evaluation. The evaluation may be a rating of your application based on your education, training and experience as they relate to the requirements of the position.�Therefore, it is essential that you provide complete and accurate information on your application.�Please report all related education, experience, dates and hours of work.�Clearly indicate your college degree and major on your application, if applicable. For education obtained outside the U.S., any job offer will be contingent on the candidate providing an evaluation for equivalency by a foreign credential evaluation service prior to starting employment (and may be requested prior to interview).�\r
Complete applications must be submitted by the closing date.�Information submitted after this date will not be added.�\r
Incorrect application forms will not be accepted.�Resumes will not be accepted in lieu of a completed application.\r
Candidates may remain on the�certified eligible list for a period of at least one year. The resulting certified eligible list for this recruitment may be used for similar positions in this or other State agencies.\r

BENEFITS

STATE OF MARYLAND BENEFITS\r

FURTHER INSTRUCTIONS

Online applications are highly recommended. However, if you are unable to apply online,�the paper application (and supplemental questionnaire) may be submitted to MDH, Recruitment and Selection Division, 201 W. Preston St., Room 114-B, Baltimore, MD 21201.�Paper application materials must be received by 5 pm, close of business, on the closing date for the recruitment, no postmarks will be accepted.\r
If additional information is required, the preferred method is to upload.� If you are unable to upload, please fax the requested information�to �Only additional materials that are required will be accepted for this recruitment. All additional information must be received by the closing date and time.\r
For questions regarding this recruitment, please contact the�MDH Recruitment and Selection Division at \r
If you are having difficulty with your user account or have general questions about the online application system, please contact the MD Department of Budget and Management, Recruitment and Examination Division at or��\r
Appropriate accommodations for individuals with disabilities are available upon request by calling: or MD TTY Relay Service \r
We thank our Veterans for their service to our country.\r
People with disabilities and bilingual candidates are encouraged to apply.\r
As an equal opportunity employer, Maryland is committed to recruitment, retaining and promoting employees who are reflective of the State's diversity.\r

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