State of Maryland

A Purchased Care Supervisor II is the highly responsible second level of supervisory work involving responsibility for the operation and maintenance of a specific phase of the workload within the Medical Assistance Operations Administration. Employees in this classification are responsible for planning, assigning, reviewing, and evaluating the work performed by their assigned staff in the processing of Medical Assistance claims, the maintenance of Recipient or Provider Master Files, the performance of certain support services, or other similar operations in the Medical Assistance Program.  Employees in this classification exercise independent judgment and initiative in order to assure efficient methods of operation and make effective recommendations for improving work methods and procedures by planning and evaluating existing workloads and procedures, determining priorities, providing leadership and assuring the most efficient use of personnel and equipment.  Employees in this classification must have the ability to use good judgment, tact, and resourcefulness in dealing with a variety of outside persons and agencies, including providers of medical services, recipients, State and federal agencies, and the general public.; errors in judgment could cause serious and expensive problems affecting the payment of Medical Assistance claims.  Employees in this classification are responsible for supervising highly complex manual and automated systems requiring expert knowledge of Program policies and regulations, ability to interpret systems-generated reports, and expert knowledge of the operations of the individual units as well as working knowledge of how each of the other units in the Program operates.  Employees in this classification must be thoroughly familiar with the application of strict security measures since most of the work supervised in these units involves confidential information and negotiable instruments. Employees in this classification are responsible for the direct supervision of the staff assigned to the unit.

Employees in this classification function under the general supervision and direction of a Section Manager or other designated agency official.  Work is evaluated through observation and analysis of manually prepared or systems generated reports in terms of production standards, quality, and transaction processing time.

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.

Supervises and provides leadership to an operational unit in the conduct of a distinct phase of the workload of the Medical Assistance Operations Administration;

Traces complex claims payment problems through the claims payment system to resolve problems with providers concerning delayed payments and rejected claims;

Controls the maintenance, update, and entry of data into computer-based master files;

Plans, assigns and reviews the work of the unit;

Reviews and interprets management and administrative reports concerning unit production and error rates, and exercises supervisory judgment to implement actions necessary to correct production backlogs, reduce errors; and resolve discrepancies;

Authorizes override of specified claims payment edits in the automated claims payment systems;

Participates in the selection, appointment, and evaluation of personnel assigned to the unit;

Implements and administers general administrative and personnel policies;

Trains subordinate personnel in the structure, content and interpretation of Medical Assistance regulations and guidelines, and in claims processing procedures, including on-line inquiry, recipient and provider eligibility files, reference files, ID card production, and records maintenance and retrieval;

Participates in the development and preparation of manual and on-line operating procedures;

Communicates Medicaid Quality Control corrective actions and Policy Instruction Statements to unit personnel and supervises implementation of corrective actions and Policy revisions;

Makes recommendations to improve office procedures and internal controls;

Provides technical information concerning processing or file maintenance procedures to other agencies, such as State and Federal auditors and investigators;

Maintain problem identification and reporting system at operating unit level to detect and prevent operating problems;

Maintains positive relationships with Medicaid providers and with other State and federal Agencies through daily communication and by providing prompt, courteous, informative responses to inquiries;

Performs other related duties.

Knowledge, at the expert level of understanding, of modern office practices, procedures and equipment;

Knowledge of business English, spelling, punctuation and grammar;

Knowledge of basic arithmetic;

Knowledge of office management and supervision of clerical activities;

Ability to understand complex automated systems such as claims processing, recipient eligibility or provider eligibility systems, including the ability to perform trouble-shooting tasks in the event of apparent system malfunction;

Ability to interpret and apply Medical Assistance regulations and guidelines in the processing of claims, enrollment of providers or recipients or other operational activities;

Ability to work independently on complex claims payment problems or other operational problems;

Ability to organize the workload of the unit for the purposes of controlling, processing and avoiding excessive backlogs;

Ability to control claims production in order to meet federal claims payment cycle time standards;

Ability to maintain harmonious working relationships with other employees, including clerical personnel, professional employees, and administrative officials.

Education:   Graduation from an accredited high school or possession of a high school equivalency certificate.

Experience: Five years of experience performing fiscal-clerical or claims processing work in health, government, insurance or other related work setting.  One year of this experience must have included responsibility for the direction and control of the work performed by subordinate staff.

Notes:

1. Candidates may substitute additional education from an accredited college or university at the rate of 15 credit hours for six months of experience for up to three years of the required general experience.

2. Candidates may substitute additional experience as defined above on a year-for-year basis for the required education. 

Class specifications are broad descriptions covering groups of positions used by various State departments and agencies. Position descriptions maintained by the using department 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 not assigned to a bargaining unit, as indicated by the designation of S (Supervisor), M (Manager), T (Agency Head), U (Board or Commission Member), W (Student), X (Used by Agency or Excluded by Executive Order), or Z (Confidential).  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 State Personnel and Pensions Article, Section 8-305.