MEDICAL ASSISTANCE PROGRAM REPRESENTATIVE SUPERVISOR 22502

9/1/90 B

This is the second class in the Medical Assistance Program Representative series. Positions are responsible for providing technical, advisory and consultative services to providers; correcting data files; and compiling statistical reports. Positions supervise the staff and activities of the assigned unit; evaluate employee performance, develop performance standards, and administer personnel policies and procedures; schedule work; respond to issues pertaining to providers; and explain Medicaid procedures to staff and health care providers. Positions are working supervisors of a unit, oversee operations, set up work procedures, and resolve issues and problems. This class is distinguished from the Medical Assistance Program Representative by its responsibility for oversight of a single program component.

Complexity of Work: Performs work of moderate difficulty in coordinating and overseeing unit activities related to the dissemination of program policy, procedures, claims, billing and other information to health care providers, recipients and others. Serves as the working supervisor of the unit by planning, scheduling, delegating and monitoring the work activities of staff. Establishes job standards and evaluates job performance of employees in the unit. Positions in this class coordinate and supervise, on a daily basis, a single component of medical assistance services. Positions supervise activities related to maintaining liaison between the agency and hospitals, nursing homes, pharmacies, and physicians. Responsibilities exist for supervising cost settlements, auditing procedures, enrollment procedures, program utilization reports, final settlement payments, provider contact, and professional relations. May supervise provider inquiry, which involves scheduling staff for the help-line, organizing training seminars, and resolving issues pertaining to provider services; provider training, resolve appeals, make presentations before groups, provide technical guidance to providers and department staff, and address appeals at the first step;provider enrollment screen provider applications for eligibility, authorize enrollment periods and re-certifications, verify Medicare/Medicaid automated file crossover and daily reports, and resolve related issues; recipient services, resolve recipient billing problems, and explain policies and procedures to recipients, the public, and local and regional Department of Social Services agencies on eligibility and enrollment; quality control/claims processing to ensure funds are properly allocated based on compliance review; or claims review and processing.

Supervision Given: Provides oversight and guidance to a staff of Medical Assistance Program Representatives and/or program support and office services staff engaged in disseminating medical assistance program information to health care providers and related administrative and support activities.

Supervision Received: Receives general direction from a Medical Assistance Program Supervisor who reviews unit work productivity and recommendations related to meeting program goals.

Scope: Positions in this class assess and determine the type and extent and quality of information given to health care providers and recipients by unit staff.

Impact of Actions: Work has serious impact on decisions related to agency programs and on the utilization of human resources.

Personal Contacts: Frequent internal and external contacts with health care providers, the Office of the Attorney General, state agencies and local agencies, professional and community organizations, professional and technical health care specialists and the fiscal agent to clarify Medicaid policies, procedures and regulations, respond to inquiries, clarify adverse decisions, provide training, obtain advice on policy issues, promote the goals of the agency and resolve problems.

Knowledge: Considerable knowledge of health care policies and procedures; health care industry; health care payment systems; and medical and pharmaceutical terminology. Knowledge of supervisory principles and practices; planning methods; of microcomputer, minicomputer and/or mainframe applications; and of training and evaluation techniques.

Skills: Working skill in keyboarding.

Abilities: Demonstrated ability to supervise subordinate staff; serve as a team leader; interpret state and federal health care policies, procedures and regulations; communicate effectively orally and in writing; delegate work assignments; establish job standards and evaluate job performance; plan and schedule unit work activities; and conduct one-on-one or group training programs.

QUALIFICATIONS GUIDE*

Licenses or Certification: None.

Education or Training: Graduation from an accredited college or university with course work in business or health care administration, or a related field.

Level and Type of Experience: Experience in a social science or health care setting leading or supervising policy and procedure information.

An equivalent combination of training and experience indicating possession of the preceding knowledge and abilities may substitute for this education and experience.

This class specification is a revision of the Medical Assistance Program Representative Supervisor class, effective September 1990.