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MEDICAL CARE PROGRAM SUPERVISOR

Recruitment #16-000931-0002

GRADE

16

LOCATION OF POSITION

DHMH, Office of Systems, Operations and Pharmacy, Baltimore, MD

Main Purpose of Job

The main purpose of this position is to develop, make recommendations and implement medical assistance claims unit policies, regulations. This employee will manage, supervise and train supervisors and lower level staff of the Claims Processing Division in the Office of Systems, Operations, and Pharmacy of the Medical Programs Administration at the Department of Health and Mental Hygiene. This individual has general oversight of the departments functions, leading the department to be able to handle a high volume of claims. This position requires an individual to perform each job responsibility for successful job performance and have management level claims experience. The employee will follow all state and federal regulations when determining responsible payer, coding of the claims and ensuring that clean claims are filed to each payer. The individual must direct the planning, design, development, implementation and evaluation of policies and procedures that assure accurate, timely claims processing and provider inquiries (written or verbal). Assure timely and accurate processing of claims, response to provider telephone calls, written inquiries, and appeals. The ability to compile all necessary information and documents required for claims processing and related inquiries to assure compliance with the applicable rules, regulations, and external and internal policies and procedures.

MINIMUM QUALIFICATIONS

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

Experience: Four years of administrative or professional experience developing or applying policies and regulations in medical assistance, health insurance, federal or State entitlement programs. One year of this experience must have been in a medical assistance program.

Note: 1. Additional administrative or professional experience developing or 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.

2.  A Master's degree in the related field of work can be substituted for the required experience.

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

DESIRED OR PREFERRED QUALIFICATIONS

Desired candidates should possess supervisory experience and should be knowledgeable about claims processing.

LICENSES, REGISTRATIONS AND CERTIFICATIONS

Employees in this classification may be assigned duties which require the operation of a motor vehicle. Employees assigned such duties will 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.  Applicants certified to list will receive eligibility for a period of one (1) year.  Eligibility may be extended beyond one (1) year period.

Online applications are highly recommended, however the paper application may be submitted 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.

Should additional information regarding this recruitment be required, please contact the DHMH Recruitment and Selection Division at 410-767-1251 or via email at dhmh.jobs@maryland.gov

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

BENEFITS

FURTHER INSTRUCTIONS

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

The resulting certified eligible list for this recruitment may be used for similar positions in this or other State agencies.

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

Bilingual applicants are encouraged to apply.




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