This information is for reference only. These classifications are no longer valid and were replaced 7/1/2020.
This is mid-level technical work maintaining the operation of a unit within the Medicaid Program with the Missouri Department of Social Services.
Applicants must meet one of the following eligibility requirements:
(The following minimum qualifications will determine merit system eligibility. Allowable experience and education substitutions are provided in italics below the corresponding minimum qualification statement; no other substitutions will be permitted. These minimum qualifications may also be used to evaluate applicants for Missouri Uniform Classification and Pay System positions not requiring selection from merit registers.)
One or more years of experience as a Medicaid Clerk or Administrative Office Support Assistant with the Missouri Department of Social Services; and possession of a high school diploma or proof of high school equivalency.
OR
Five or more years of experience in one or more of the following fields: health care provider relations, insurance claims processing, medical billing, medical diagnostic and procedure coding, bookkeeping or comparable record keeping, financial eligibility assessment, health care regulations development/enforcement, or similar work, of which two 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 work); and possession of a high school diploma or proof of high school equivalency.
(Earned credit hours from an accredited college or university may substitute on a year-for-year basis for a maximum of four years of the required general and/or specialized experience at a rate of 30 earned credit hours for one year.)
(24 earned graduate credit hours from an accredited college or university in the areas of Public, Business, or Health Care Administration; Health Sciences; Nursing; Medical Technology; Social Work; Finance; or Accounting may substitute for one year of the required general or specialized experience.)
This description may not include all of the duties, knowledge, skills, or abilities associated with this classification.
Analyzes and evaluates claims, financial, and recurrent statistical data to identify patterns of Medicaid utilization and abuse, program inefficiency, and non-compliance; determines and initiates corrective procedures and actions.
Monitors unit and program operations to ensure compliance with federal regulations, procedures, and audit recommendations.
Evaluates and develops technical procedures, implementing federally mandated program changes, coordinating inter-unit and inter-agency Medicaid procedures and training or supervising staff.
Provides technical assistance to administrators; answers non-routine inquiries from medical vendors and recipients, revises unit and program operations, and prepares administrative reports.
Designs and develops procedures for efficient and economical operation of the unit and associated programs; coordinates implementation of policies and procedures with providers, the Family Support Division, and other agencies.
Assists managers and other staff in developing operating procedures; serves as liaison between program staff and information technology staff to relay systems needs.
Explains and interprets difficult and complex rules, regulations, and procedures of assigned programs to public officials, providers, recipients, subordinates, and other staff members.
Monitors cost avoidance data maintained in recipient eligibility files; reviews reports and referrals from providers and division staff in order to detect discrepancies; and obtains and reviews state, federal, and other records to resolve discrepancies and initiate corrective action.
Reviews and evaluates detailed claims payment data to identify and initiate recoupment of overpayments due to recipient enrollment in Medicare or other health insurance programs.
Identifies potentially liable third party resources and initiates actions to recoup Medicaid payments.
Collects and analyzes utilization data of physician sponsors in the Managed Health Care Program.
Trains unit staff on program policy and procedures.
Compiles and prepares administrative and technical reports relating to program problems, procedural changes, corrective actions, and production statistics.
Reviews and prepares analysis of vendor claims and services and recipient utilization patterns.
Supervises technical and clerical staff engaged in the daily operations of the unit.
Achieves objectives and maintains efficient operations; receives general supervision from a designated administrative supervisor.
Performs other related work as assigned.
Intermediate knowledge of federal and state laws, rules, regulations, and procedures governing the operation of the Title XIX Medicaid Program.
Intermediate knowledge of the preparation, location, and use of computerized information systems, reference manuals, reporting systems, and other related resource documents and files used in the operation of the Medicaid Program.
Intermediate knowledge of medical terminology and diagnostic coding used in the Medicaid Program.
Intermediate knowledge of the general procedures used in initiating, processing, and evaluating medical claims.
Intermediate knowledge of procedures and techniques of collecting, organizing, and evaluating simple statistical and Medicaid financial data.
Introductory knowledge of the supervisory principles and techniques.
Ability to communicate effectively.
Ability to solve technical problems in routine program operations.
Ability to supervise assigned staff.