This information is for reference only. These classifications are no longer valid and were replaced 7/1/2020.
This is responsible supervisory and administrative work assisting in the operation of the Medicaid program of the Division of Medical Services.
An employee in this class is responsible for supervising a unit in the Division of Medical Services and providing administrative assistance to a program administrator. Work includes supervising and training subordinate staff; planning, developing and evaluating unit activities and operations; explaining procedures and regulations; developing reports; and resolving a variety of administrative problems. Work may include independent responsibility for providing administrative assistance directly to a deputy director in the administration and coordination of the total Medicaid program. Supervision is given to a professional and technical staff. General supervision is received from a deputy director or other designated administrative superior for conformance to program policy and guidelines.
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. These minimum qualifications may also be used to evaluate applicants for Missouri Uniform Classification and Pay System positions not requiring selection from merit registers.)
Two years of experience at the level of Medicaid Specialist, Medicaid Program Relations Representative, Program Development Specialist, Budget Analyst II or Management Analysis Specialist I in the Missouri Division of Medical Services.
OR
Four years of professional or technical experience in a Medicaid program; Medicaid utilization analysis; health care provider relations; medical insurance claims processing; health care administration; or related work, of which two years must have been in a supervisory, consultative, administrative or advanced technical capacity at the level of Medicaid Specialist, Medicaid Program Relations Representative, Program Development Specialist, Budget Analyst II or Management Analysis Specialist I; and graduation from an accredited four-year college or university with specialization in public, business or health care administration, nursing, health sciences, social work, finance, accounting or related areas. (Graduate work in the specified educational areas may be substituted on a year-for-year basis for the general experience and for one year of the specialized experience.)
OR
Four years of supervisory or consultative experience in financial eligibility determinations at the level of Income Maintenance Supervisor I or Case Analyst; and graduation from an accredited four-year college or university with specialization in public, business or health care administration, nursing, health sciences, social work, finance, accounting or related areas. (Graduate work in the specified educational areas may be substituted on a year-for-year basis for the general experience and for one year of the specialized experience.)
This description may not include all of the duties, knowledge, skills, or abilities associated with this classification.
Assists a deputy director or other designated superior in planning, evaluating and implementing program or unit activities, including recommending and preparing plans to implement program changes as deemed appropriate.
Communicates with officials of the Department of Health and Human Services, officials of other states, professional service organizations, federal and state legislators, providers and recipients to answer questions, explain procedures and assist in the resolution of common problems.
Determines need for administrative actions against providers and makes recommendations as to the type of action to be employed.
Determines retroactive cost adjustments due on hospital claims and reconciles differences between hospital figures and the intermediaries.
Prepares expenditure summaries for the Medicaid program; monitors program allotments; controls and monitors accounts receivables/receipts; and prepares financial reports.
Assists in developing the claims payment and financial processing and reporting system, and develops cash control policies and procedures to insure correct federal reporting.
Develops, monitors and directs the system editing and post payment recovery process for Medicare cost avoidance.
Plans and develops work procedures, systems and policies for the Buy-In Program.
Prioritizes and administers changes to the Medicaid Management Information System.
Coordinates the provider education function of the division; schedules provider training via seminars and workshops.
Monitors claim-filing problems and advises the deputy director of specific areas which require additional instruction or clarification.
Ensures compliance with federal standards regarding enrollment of providers in the program.
Coordinates activities between the various units of the Division of Medical Services, federal and state agencies, providers, the fiscal agent, public agencies and private entities in order to meet common objectives and develop uniform procedures.
Develops and provides Medicaid training to staff in the Department of Social Services and other departments of state government.
Supervises designated subordinate staff.
Performs other related work as assigned.
Thorough knowledge of the principles and practices of administration and office management.
Thorough knowledge of federal and state laws, regulations and procedures governing the operation of the Title XIX Medicaid Program.
Considerable knowledge of medical terminology and diagnostic coding used in the Medicaid program.
Considerable knowledge of the general procedures used in initiating, processing and evaluating medical claims.
Considerable knowledge of methods and techniques used in preparing technical reports and procedures manuals.
Working knowledge of business practices of hospitals, clinics, nursing homes, pharmacies, accounting firms and insurance agencies.
Working knowledge of supervisory principles and techniques.
Ability to analyze and evaluate a variety of laws, rules, regulations and procedures and technical data pertaining to the Medicaid program, make logical inferences and draw sound conclusions based on this data.
Ability to work effectively with a variety of technical and professional staff in the Medicaid field.
Ability to communicate effectively.