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MEDICAL CARE PROGRAM SPECIALIST II

FULL-TIME CONTRACTUAL

Recruitment #14-999999-710

GRADE

15

LOCATION OF POSITION

Department of Health and Mental Hygiene

Medical Care Programs-Office of Health Services

Long Term Supports and Services Administration

201 W. Preston Street

Room 214

Baltimore, MD 21201

Main Purpose of Job

The Contractual Medical Care Program Specialist II is the full performance level of work developing and applying medical assistance policies and regulations. These positions complete Plan of Service (POS) reviews, complete Authorization to Participate (ATP) and provider enrollment reviews, and monitor Supports Planning Agencies (SPAs).

For POS reviews, reviewers will review participants' plans of service (POS) to ensure that needs are met, health and safety issues are addressed, cost requirements are met and decisions are made in accordance with State and Federal regulations.  Reviewers will effectively communicate, orally and in writing, with the statewide network of service providers, supports planning agencies and health care officials at the State and Federal level.  Reviewers will monitor and track the POS review process and apply State and Federal guidance to determine the impact on service delivery.  Reviewers will report on POS progress to management.

For ATP reviews and provider enrollment, these individuals will verify eligibility and enroll participants, verify credentials and enroll providers, provide support to enrolled providers, act as a liaison with participants, providers, and support planners in issues related to policy and regulations for the programs.  Specialists will also perform audits of provider claims, investigate billing issues, and resolve problems related to enrollment.  These individuals monitor utilization, billing, and compliance with program rules.

For monitoring SPAs, employees will offer guidance on policy and procedures to Supports Planning Agencies on a regular basis.

MINIMUM EDUCATION AND EXPERIENCE REQUIREMENTS

Education:    A Bachelor's degree from an accredited college or university.

Experience:  Three years of administrative or professional experience developing or applying policies and regulations in medical assistance, health insurance, federal or State entitlement programs.

NOTE:

Additional 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 may be substituted on a year-for-year basis for the required education.

LICENSES, REGISTRATIONS AND CERTIFICATIONS

Employees in this classification may be assigned duties which require the operation of a motor vehicle. Employees assigned such duties may be required to possess a motor vehicle operator's license valid in the State of Maryland.

SELECTION PROCESS

Applicants who meet the minimum qualifications will be evaluated. The evaluation may be a rating of your application based on your education, training and experience as they relate to the requirements of the position. Therefore, it is essential that you provide complete and accurate information on your application. Please report all related education, experience, dates and hours of work. For education obtained outside the U.S., a copy of the equivalent American education as determined by a foreign credential evaluation service must accompany the application. All information concerning your qualifications must be submitted by the closing date. We will not consider information submitted after this date. For Recorded Job Information Call: 410-767-6018.

BENEFITS

This is a full-time contractual position with no benefits.

FURTHER INSTRUCTIONS

Online application process is STRONGLY preferred. If online process is not available, please send your paper application to: DHMH, Recruitment and Selection Division, 201 W. Preston St., Room 114-B, Baltimore, MD 21201. The paper application must be received by 5 pm, close of business, on the closing date for the recruitment, no postmarks will be accepted.

Incorrect application forms will not be accepted.

If you need to submit additional information, the preferred method is to upload. If unable to upload, please fax requested information only to 410-333-5689.

Appropriate accommodations for individuals with disabilities are available upon request by calling: (410) 767-1251 or MD TTY Relay Service 1-800-735-2258.

We thank our Veterans for their service to our country, and encourage them to apply.

As an equal opportunity employer Maryland is committed to recruiting, retaining and promoting employees who are reflective of the State’s diversity.




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