State of Maryland

A Medical Care Program Specialist Trainee is the entry level of staff work developing and implementing medical care program policies and regulations that specifically impact one or more Medical Care Programs for the Maryland Department of Health (MDH).  Employees in this classification do not supervise other positions.

Employees in this classification receive close supervision from a Medical Care Program Supervisor or Manager, or a health care professional.

Positions in this classification are evaluated by using the classification job evaluation methodology.  The use of this method involves comparing the assigned duties and responsibilities of a position to the job criteria found in the Nature of Work and Examples of Work sections of the class specification.

The Medical Care Program Specialist Trainee, Medical Care Program Specialist I and Medical Care Program Specialist II are differentiated on the basis of degree of supervisory control exercised by the supervisor.  The Medical Care Program Specialist Trainee learns to perform duties under close supervision.  The Medical Care Program Specialist I performs duties under moderate supervision or independently depending upon the complexity of the specific tasks performed.  The Medical Care Program Specialist II performs a full range of duties and responsibilities under general supervision.

Learns to develop and implement Medical Care Program policies and regulations specific to the Medical Care Program services assignment;

Learns to prepare program specific studies, surveys and reports related to the Medical Care Program services;

Learns to identify discrepancies in case management, billing, pricing and payment records for Medical Care Program services and make recommendations for corrective actions;

Learns to interpret and apply Medical Care Program policies and regulations;

Learns to make recommendations for implementing changes to Medical Care Program services;

Learns to act as a liaison with public and private agencies regarding Medical Care Program services;

Learns to provide consultation and assistance to public and private agencies regarding Medical Care Program services;

Learns to develop and participate in training programs concerning Medical Care Program services;

Learns to participate in the utilization review of Medical Care Program services for quality assurance;

Performs other related duties.

Ability to learn Medical Care Program eligibility, policy, and regulations;

Ability to learn Medical Care Program provider policy and regulations;

Ability to learn utilization review and control techniques;

Ability to learn Medical Care Program claims adjudication operations;

Ability to learn Medical Care Program audit principles;

Ability to learn to evaluate third party liability;

Ability to learn Medical Care Program recipient needs;

Ability to learn about individual providers, agencies, facilities, and community organizations providing services to Medical Care Program recipients;

Ability to learn to conduct and participate in research programs, studies, and surveys;

Ability to learn to present long-range plans to various public and professional groups;

Ability to prepare informative and accurate reports on program accomplishments.

Ability to learn the management information systems used by the Medical Care Program.

Experience: Four years of administrative or professional experience applying policies and regulations in medical assistance, health insurance, federal or State entitlement programs or in a health or human service program.

Notes:

1. Candidates may substitute the possession of a Bachelor's degree from an accredited college or university for the required experience.

2. Candidates may substitute U.S. Armed Forces military service experience as a commissioned officer in Operational Analysis classifications or Health Services Management specialty codes in the health related field of work on a year-for-year basis for the required experience.

Class specifications are broad descriptions covering groups of positions used by various State Departments and agencies. Position descriptions maintained by the using departments or agency specifically address the essential job functions of each position.

This is a Skilled Service classification in the State Personnel Management System.  All positions in this classification are Skilled Service positions.  Some positions in Skilled Service classifications may be designated Special Appointment in accordance with the State Personnel and Pensions Article, Section 6-405, Annotated Code of Maryland.

This classification is assigned to Bargaining Unit E, Health Care Professional classes.  As provided by State Personnel and Pensions Article, Section 3-102, special appointment, temporary, contractual, supervisory, managerial and confidential employees are excluded from collective bargaining.  Additionally, certain executive branch agencies are exempt from collective bargaining and all positions in those agencies are excluded from collective bargaining.

Employees in this classification are eligible to receive overtime compensation.  An employee who works more than the normal workweek is entitled to be compensated for that overtime, as provided by the State Personnel and Pensions Article, Section 8-305.

This classification is one level in a Non-Competitive Promotion (NCP) series.  NCP promotions are promotions by which employees may advance in grade and class level from trainee to full performance levels in a classification series.  In order to be non-competitively promoted to the next level in a NCP series, an employee must: 1) perform the main purpose of the class as defined in the Nature of Work section of the class specification; 2) receive the type of supervision defined in the class specification, and 3) meet the minimum qualifications of the classification.