- Medicaid Program Relations Representative
- What will I be doing?
- Do I qualify?
- Can I be successful?
- How do I apply?
This is professional and technical work in the planning, development and implementation of the medicaid provider program(s) of the Division of Medical Services.
An employee in this class is responsible for assisting providers in resolving complex technical problems involving the state medicaid fee for service and managed care programs and providing instructions in the procedures for submitting medicaid claims for payment. Work involves researching complex inquiries and problems and assuring that providers and recipients are advised of correct procedures. Work also includes developing, planning and presenting instruction on procedures for filing claims and resolving problems. General supervision is received from a designated administrative superior; however, by nature of the assignment the incumbent is expected to work with considerable independence.
Plans, develops and presents workshops and seminars throughout the state to train medical providers and Division of Family Services county staff in policies and procedures of the fee for service and managed care medicaid program.
Explains the medicaid program to provider and recipient groups.
Studies the principles of training and plans the content and method of program presentation in consultation with administrative superiors and other staff.
Keeps abreast of current state and federal laws and regulations relating to the Title XIX program, managed care, policy and procedures, fee schedules, procedure diagnosis codes and other medicaid information.
Works with division staff in developing provider bulletins, newsletters and manuals to keep the medical providers informed of medicaid information.
Travels to medicaid provider establishments to provide technical assistance in such areas as program policy, billings, resolution of claims payment problems, etc.
Answers questions regarding eligibility, policies and procedures, pricing and fee structure, questionable claims and other related inquiries.
Confers with medical consultants, representatives of the fiscal agent, representatives of professional organizations and others concerned with the medicaid program to provide information and resolve problems related to the medicaid program.
Develops and maintains working relationships with representatives of provider associations and members of the Medical Advisory Committee.
Informs management staff of reactions to policy changes and/or program difficulties which providers or recipients are experiencing.
Answers and resolves medical coverage problems of recipients and provides initial hearing for appeals initiated by recipients.
Performs other related work as assigned.
(The following minimum qualifications will determine merit system eligibility. Allowable experience and education substitutions are provided in italics below the corresponding minimum qualification statement. These minimum qualifications may also be used to evaluate applicants for Missouri Uniform Classification and Pay System positions not requiring selection from merit registers.)
Four years of professional or technical experience in one or more of the areas described below and graduation from an accredited four-year college or university. (Graduate study in an accredited college or university in public administration, health care administration, behavioral sciences, journalism or related areas may be substituted on a year-for-year basis for the stated experience.)
Please note that documentation that supports your eligibility (i.e. transcripts, employment records, etc.) may be required at any time during the application and hiring process. If you do not possess the minimum qualifications, please consider one of many other employment opportunities with the State of Missouri.
Do you possess the key skills which are considered essential for successful employment in this classification?
Considerable knowledge of the Title XIX Medicaid policies, procedures and guidelines of the Division of Medical Services.
Considerable knowledge of methods of instruction, preparation of training materials and organization of informational programs.
Considerable knowledge of the provisions of state and federal laws and regulations pertaining to the Title XIX Medicaid program.
Considerable knowledge of the general procedures used in the initiation, processing and evaluation of medical claims.
Working knowledge of methods and techniques used in preparing procedures manuals, bulletins, pamphlets and newsletters.
Some knowledge of the use of computerized information systems and other resource documents used in the medicaid program.
Some knowledge of medical terminology and coding used in the medicaid program.
Skill in working with medical providers and recipients.
Ability to assist management in determining provider training needs, prescribe the training required, and develop appropriate training materials.
Ability to evaluate laws, rules and regulations pertaining to the medicaid program.
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