Medicaid Services Specialist

Open to State of DE Dept of DHSS Merit Employees Only

Recruitment #082114-MDBZ10-350200

Summary Statement

The incumbent in this position determines financial and technical eligibility for Delaware residents for Long Term Care Medicaid programs which include the Nursing Home program, and five Home and Community based Waiver programs.  Responsibilities include:  providing caseload and eligibility determination assistance to the full-time Program of All-Inclusive Care for the Elderly (PACE) liaison, managing various Community Medicaid programs and Food Benefit programs for the elderly and disabled populations, and writing reports as required

Essential Functions

Essential functions are fundamental, core functions common to all positions in the class series and are not intended to be an exhaustive list of all job duties for any one position in the class. Since class specifications are descriptive and not restrictive, incumbents can complete job duties of similar kind not specifically listed here.
  • Reviews Medicaid policies and procedures with service providers and explains billing procedures.
     
  • Authorizes approval for reimbursements for new equipment based on review of  previous approval for similar equipment, and in accordance with Medicaid guidelines.
     
  • Conducts training to service providers and medical personnel regarding covered equipment, billing and coding procedures.
     
  • Reviews claims submitted by service providers to ensure information is valid and in compliance with regulations.
     
  • Confers with other administrative staff, medical consultants, and community representatives as necessary to resolve policy and payment issues.
     
  • Initiates and develops guidelines/policies for various Medicaid services and recommends program changes.
     
  • Participates with other administrative staff in conducting program analysis and responding to requests for information from providers, government officials and other agencies.
     
  • Revises procedure and coding manuals for use by providers.

Job Requirements

JOB REQUIREMENTS for Medicaid Services Specialist
Applicants must have education, training and/or experience demonstrating competence in each of the following areas:

  1. Six months experience in benefits claims processing such as health, dental, or life. 
  2. Six Months experience in using an automated information system to enter, update, modify, delete, retrieve/inquire and report on data.
  3. Six months experience in interpreting Medicaid laws, rules, regulations, standards, policies and procedures.
  4. Six months experience in narrative report writing.
  5. Knowledge of medical terminology.

Additional Posting Information

Applicants may only apply if they are current permanent employees of the State of Delaware Department of Health & Social Services in a position covered by the Merit System who have completed their initial probationary period.

Benefits

To learn more about the comprehensive benefit package please visit our website at http://ben.omb.delaware.gov/

Selection Process

The application and supplemental questionnaire are evaluated based upon a rating of your education, training and experience as they relate to the job requirements of the position.  It is essential that you provide complete and accurate information on your application and the supplemental questionnaire to include dates of employment, job title and job duties.  For education and training, list name of educational provider, training course titles and summary of course content.   Narrative information supplied in response to the questions must be supported by the information supplied on the application including your employment, education and training history as it relates to the job requirements. 

Once you have submitted your application on-line, all future correspondence related to your application will be sent via email.  Please keep your contact information current.  You may also view all correspondence sent to you by the State of Delaware in the “My Applications” tab at www.delawarestatejobs.com.

Accommodations

Accommodations are available for applicants with disabilities in all phases of the application and employment process.  To request an auxiliary aid or service please call (302) 739-5458. TDD users should call the Delaware Relay Service Number 1-800-232-5460 for assistance.  The State of Delaware – An Equal Opportunity and Affirmative Action Employer.