ADMINISTRATIVE SPECIALIST II
|Department||MDH Med Care Prgms - Ofc Systems Ops Pharmacy|
|Date Opened||9/18/2018 11:55:00 AM|
|Filing Deadline||1/30/2019 11:59:00 PM|
|Salary||$15.52 - $19.92/hour|
|HR Analyst||Carolyn Chase|
LOCATION OF POSITION
MDH, Office of Systems, Operations, and Pharmacy, Baltimore, MD
Main Purpose of Job
Administrative Specialist II is the full performance level of administrative work requiring regular use of independent judgment and analysis in applying and interpreting rules and regulations in accordance with agency laws and policies. The main purpose of this position is to validate insurance coverage for Medical Assistance recipients based on referrals received from various sources. Once the referrals are received contacts are made to insurance carriers, Federal and State agencies, employers, Managed Care Organizations (MCO), etc. to verify insurance coverage. This position reviews and analyzes Third Party Liability (TPL) coverage in various forms to insure and prevent fraud of Medicaid due to the recipient having unreported private insurance coverage. The position must have a good understanding of COMAR regulations and how to apply them, be able to review and analyze paid Medicaid claims, initiate new claims (where applicable) to various insurance carriers, handle all follow-up contact with insurance carriers telephonically and by US mail, contact medical assistance providers of service and recipients through the resolution of filed claims. This position must interpret and apply Federal and State regulations daily relating to third party recovery of health insurance and must be able to add detailed notes and follow up information in various applications including Google Forms.
Education: Completion of 60 credit hours at an accredited college or university.
Experience: One year of experience in administrative or professional work.
1. Candidates may substitute experience as defined above for the required education at the rate of one year of experience for 30 credit hours, for up to 60 credit hours of required education.
2. Candidates may substitute 90 credit hours at an accredited college or university for the required education and experience.
3. Candidates may substitute U.S. Armed Forces military service experience as a non-commissioned officer involving staff work requiring regular use of independent judgment and analysis in applying and interpreting rules and regulations in accordance with agency laws and policies on a year-for-year basis for the required education and experience.
DESIRED OR PREFERRED QUALIFICATIONS
The successful applicant should have knowledge and experience with Medical Care Program's policies, procedures and regulations as it applies to Managed Care Organizations and have knowledge of third party liability programs through which other sources of payments for Medical Assistance recipient's health care are discovered, and monies spent on behalf of the recipient is recovered from sources allowed by federal or state law.
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.
Applicants who meet the minimum (and selective) qualifications will be included in further evaluation. 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. Clearly indicate your college degree and major on your application, if applicable. For education obtained outside the U.S., any job offer will be contingent on the candidate providing an evaluation for equivalency by a foreign credential evaluation service prior to starting employment (and may be requested prior to interview). Complete applications must be submitted by the closing date. Information submitted after this date will not be added. Candidates may remain on the certified eligible list for a period of at least one year.
Online applications are highly recommended. However, if you are unable to apply online, the paper application may be submitted to MDH, 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 additional information is required, the preferred method is to upload. If unable to upload, please fax requested information only to 410-333-5689. Only additional materials that are required will be accepted for this recruitment. All additional information must be received by the closing date and time.
Resumes will not be accepted in lieu of a completed application.
For questions regarding this recruitment, please contact the MDH Recruitment and Selection Division at 410-767-1251.
If you are having difficulty with your user account or have general questions about the online application system, please contact the MD Department of Budget and Management, Recruitment and Examination Division at 410-767-4850 or Application.Help@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.
Contractual employees who work for an agency covered under the State Employee and Retiree Health and Welfare Benefits Program (the Program), have a current employment contract and work 30 or more hours a week (or on average 130 hours per month) may be eligible for subsidized health benefits coverage for themselves and their dependents. As a contractual employee, you will be responsible for paying 25% of the premiums for your medical and prescription coverage, including any eligible dependents you have enrolled. The State of Maryland will subsidize the remaining 75% of the cost for these benefits. You can also elect to enroll in dental coverage, accidental death and dismemberment insurance, and life insurance, but will be responsible to pay the full premium for these benefits.
Leave may be granted to a temporary/contractual employee who has worked 120 days in a 12 month period. This leave accrues at a rate of one hour for every 30 hours worked, not to exceed 40 hours per calendar year.
As an equal opportunity employer, Maryland is committed to recruiting, retaining and promoting employees who are reflective of the State’s diversity. People with disabilities and bilingual candidates are encouraged to apply. We thank our Veterans for their service to our country.