Missouri Office of Administration

MEDICAID CLERK

DEFINITION

This is entry-level technical work in the MO HealthNet Division with the Department of Social Services.

This description may not include all of the duties, knowledge, skills, or abilities associated with this classification.

EXAMPLES OF WORK

Collects and organizes data, answers routine program inquiries, examines utilization patterns, assists in developing procedures, and performs other similar tasks.

Provides basic technical assistance to Medicaid Specialists, unit supervisors, or program administrators in specialized areas of the Medicaid Program.

Locates, organizes, and performs routine analyses on information from various sources (reports, procedure manuals, and medical references) pertaining to claims payments, recipient and provider statistics, insurance payments and coverage, provider enrollment, and utilization patterns.

Examines provider and recipient utilization data to identify fraud, program abuse, inappropriate usage, and system errors.

Explains well-established state Medicaid rules to providers, recipients, professional associations, governmental agencies, attorneys, other individuals, and groups; refers more difficult problems and questions to appropriate staff.

Reviews standard program forms and various reports prepared by non-agency sources for compliance with established criteria.

Reviews internal bulletins, forms, manual revisions, fee schedules, and computer generated reports for conflict with established procedures and processes.

Maintains computer files by entering data or directing clerical staff to enter data, such as: insurance information, pricing files, provider manuals, and mailing lists.

Maintains Medicaid master provider agreements.

Participates with other staff members in meetings with the fiscal agent and others to identify problem areas and develop solutions.

Prepares routine reports, studies, and documentation needed to make decisions and complete advanced projects.

Attends and participates in workshops and training sessions to improve technical competence.

Supervises a small clerical staff.

Performs other related work as assigned.

KNOWLEDGE, SKILLS AND ABILITIES (KSAs)

Introductory knowledge of federal and state laws, rules, regulations, and procedures governing the operation of the Title XIX Medicaid Program.

Introductory knowledge of the preparation, location, and use of computerized systems, reference manuals, reporting systems, and other related resource documents and files used in the operation of the Medicaid Program.

Introductory knowledge of medical terminology and diagnostic coding used in the Medicaid Program.

Introductory knowledge of the general procedures used in initiating, processing, and evaluating medical claims.

Introductory knowledge of procedures and techniques of collecting, organizing, and evaluating simple statistical and financial data.

Ability to communicate effectively.

Ability to solve complex clerical and basic technical problems in routine program operations.

Ability to supervise assigned clerical staff.

EXPERIENCE AND EDUCATION

(The following requirements will determine merit system eligibility, experience and education ratings, and may be used to evaluate applicants for Missouri Uniform Classification and Pay System positions not requiring selection from merit registers. When practical and possible, the Division of Personnel will accept substitution of experience and education on a year-for-year basis.)

One or more years of Senior Office Support Assistant [Clerical, Keyboarding, Stenography] or Account Clerk II experience with the Missouri Department of Social Services; and possession of a high school diploma or GED certificate.

OR

Four or more years of experience in one or more of the following fields: health care provider relations, insurance claims processing, medical billings, medical diagnostic and procedure coding, bookkeeping or comparable record keeping, financial eligibility assessment, health care regulations development/enforcement, or similar work, of which one or more years of experience must have been in an advanced capacity (i.e., involving responsibility for a variety of complex clerical functions or processes and/or staff supervision, requiring specialized clerical knowledge, or advanced bookkeeping and basic accounting work in the maintenance and review of detailed fiscal records, or comparable level); and possession of a high school diploma or GED certificate.

(Earned credit hours from an accredited college or university may substitute on a year-for-year basis for the required general and/or specialized experience at a rate of 30 earned credit hours for one year.)

(Revised 12/1/09)