State of Maryland

A Medical Care Program Associate II is the full performance level of work in a Medical Assistance Program in the Maryland Department of Health (MDH).  Employees in this classification apply, interpret and process program specific information, policies, regulations and guidelines in a variety of activities.  Employees in this classification do not supervise.

Employees in this classification receive general supervision from a Medical Care Program Associate Supervisor or a Medical Care Program Specialist.

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.

The Medical Care Program Associate I and Medical Care Program Associate II are differentiated on the basis of degree of supervisory control exercised by the supervisor over these employees.  The Medical Care Program Associate I performs duties under close supervision at times and under general supervision at other times depending upon the complexity of the specific duty performed.  The Medical Care Program Associate II performs the full range of duties and responsibilities under general supervision.  The Medical Care Program Associate II is differentiated from the Medical Care Program Associate Lead in that the Medical Care Program Associate Lead assigns, reviews and approves the work of and trains lower-level Medical Care Program Associates.

Reviews and verifies medical assistance data (claims forms, encounter data, enrollment forms, adjustment forms, insurance data, or other related documents) for accuracy, completeness and compliance with State and federal regulations by applying appropriate Medical Care Program regulations, policies and procedures;

Secures or obtains missing data by calling or writing involved parties and completing appropriate forms;

Reviews and determines client eligibility for Medical Assistance programs;

Contacts insurance companies, health care providers, other governmental agencies and recipients in order to verify information submitted to the Medical Care Program for payment or review;

Responds to inquiries and complaints and provides liaison services to health care providers, insurance companies, other governmental agencies and recipients;

Refers applicants to support services as appropriate;

Prepares required reports and maintains a client/provider tracking system;

Enters, codes and maintains data into automated information systems;

Handles routine telephone and mail inquiries;

Performs other related duties.

Knowledge of Medical Care Program policies, procedures and regulations relevant to health care delivery systems;

Knowledge of basic math to prepare reports;

Ability to screen and respond to visitors and telephone inquiries;

Ability to maintain routine and confidential files, logs and program data;

Ability to review Medical Assistance data to interpret, clarify or apply Medical Care Program regulations, policies, procedures or guidelines;

Ability to collect and organize statistical information and prepare concise reports;

Ability to understand, access and operate various computer information systems;

Ability to operate office equipment and develop routine office procedures;

Ability to organize and complete work according to assigned schedules;

Ability to communicate effectively with co-workers, supervisors and the general public.

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

Experience: Two years of clerical experience applying policies in a medical care, health insurance or federal or State entitlement program.

Notes:

1. Candidates may substitute additional general clerical experience on a year-for-year basis for the required education.

2. Candidates may substitute thirty credit hours from an accredited college or university for one year of the required experience.

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 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 assigned to Bargaining Unit D, Health and Human Service Nonprofessionals classes.  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 the State Personnel and Pensions Article, Section 8-305.

This classification is one level in a Non-Competitive Promotion (NCP) series.  NCP promotions are promotions by which employees may advance in grade and class level from trainee to full performance levels in a classification series.  In order to be non-competitively promoted to the next level in a NCP series, an employee must: 1) perform the main purpose of the class as defined in the Nature of Work section of the class specification; 2) receive the type of supervision defined in the class specification, and 3) meet the minimum qualifications of the classification.