MEDICAID PERSONAL FUNDS AUDITOR 23501

5/2/88 B

CLASS CONCEPT/FUNCTION

This is a journey level class in a single class series that performs field audits of Medicaid patients' personal fund trust accounts and of financial records of health care facilities. Positions in this class independently schedule and conduct field audits, determine adherence by health care facilities to state and federal regulations regarding the use of patient personal fund accounts, identify any financial adjustment that is needed as a result of the audit, and prepare audit reports on the findings of reviews of usage of personal fund accounts.

DISTINGUISHING FEATURES OF THE WORK

Complexity of Work: Performs work of moderate difficulty which requires thereview, verification, assessment, adjustment, and reporting of Medicaid patients' personal fund accounts usage by health care facilities. Incumbents review the health care provider files for prior year discrepancies, approval by social service agencies of special equipment payment which is to be reimbursed by patient personal funds, remittance vouchers, patient billing ledger cards, documentation of receipts and expenditures, and patient co-payment determination forms. Verifies that the personal fund account allowance is used only for patient personal needs, that expenditures are appropriate and that balances remaining in personal fund accounts are appropriately refunded upon discharge or death of patient. Determines if financial adjustments are necessary due to use of improper procedures of personal fund accounts and informs provider of recommendations and any adjustment to be made. Prepares reports of audit findings.

Supervision Given: Supervision is typically not a factor.

Supervision Received: Directions are received from a Medicaid Reimbursement Audit Supervisor.

Scope: Employees in this class are responsible for a specific account audit which has an effect on the organization, on health care providers, and on the economic well-being of a substantial number of people.

Impact of Actions: The quality of audit provided and conclusions reached may impact significantly on costs in terms of the Medicaid patients' economic well-being.

Personal Contacts: Frequent contacts are made with health care providers and local social service agencies in the audit of accounts.

KNOWLEDGE, SKILLS AND ABILITIES

Knowledge: Working knowledge of accrual based accounting principles and practices. Working knowledge of auditing principles and practices. Knowledge of financial and organizational structure of proprietorships, partnerships, and corporations.

Skills: None identified for this class.

Abilities: Demonstrated ability to independently perform analyses of financial data and accurately record observations, and to interpret state and federal policies and regulations as related to the Medicaid program. Demonstrated ability to effectively communicate both orally and in writing.

QUALIFICATIONS GUIDE*

Licenses or Certification: None.

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

Level and Type of Experience: Experience related to accounting and auditing in the public or private sector.

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

CLASS HISTORY

This is a new class established in September, 1986.