MEDICAID TECHNICIAN

DEFINITION

This is technical work maintaining the operation of a unit in the Division of Medical Services, with responsibility for evaluating and developing technical procedures, implementing federally mandated program changes, coordinating inter-unit and inter-agency Medicaid procedures, and training and/or supervising staff.

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

EXAMPLES OF WORK

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.

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; obtains and reviews state, federal and other records to resolve discrepancies and initiates 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 staff in unit and 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 operation in a technical unit.

Achieves objectives and maintains efficient operations; receives general supervision from a designated administrative supervisor.

Performs other related work as assigned.

KNOWLEDGE, SKILLS AND ABILITIES (KSAs)

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 systems, reference manuals, reporting systems and other 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 Medicaid data.

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

Introductory knowledge of the principles and practices of supervision.

Ability to communicate effectively.

Ability to solve technical problems in routine program operation.

Ability to supervise assigned 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 experience as a Medicaid Clerk or Administrative Office Support Assistant with the Missouri Department of Social Services.

OR

Five 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 and/or enforcement, or similar work, of which two or more years of experience must have been in an advanced capacity (Senior Office Support Assistant [Clerical, Keyboarding, Stenography], Account Clerk II or comparable level work).

(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 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, Nursing, Medical Technology, Social Work, Finance, or Accounting may substitute for one year of the required general or specialized experience.)

(Minor Revision 4/19/06)