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MEDICAL CARE PROGRAM SPECIALIST II

Quality Control Analyst

Recruitment #19-000928-0001

GRADE

15

LOCATION OF POSITION

MDH-Office of Eligibility Services/Program Integrity Unit, Baltimore, MD

Main Purpose of Job

The Maryland Department of Health (MDH) is charged with the responsibility of managing the State Medicaid Program and uses this position to achieve its goal of payment accuracy and effective and efficient administration of the Title XIX programs. Analysts contribute to detailed and informative reports for all levels of Federal, State and Local management, by applying accepted management techniques and methods to identify, explain and/or resolve systems, policy, procedural and administrative problems.

The main purpose of this position is to conduct desk audits, investigate, analyze and evaluate Medicaid Eligibility program decisions processed by eligibility case managers and/or reviewed by eligibility supervisors, at the Local Departments of Social Services (LDSS) under the Department of Human Services (DHS), the Local Health Departments (LHD) under the Maryland Department of Health (MDH), the Eligibility Determination Division under the MDH Office of Eligibility Services and various other MDH units. Specifically, this position will examine the casework performed in several eligibility systems -- the Maryland Health Connection (MHC), the Eligibility & Exchange system (E&E), the eMedicaid system, the Healthy Maryland system and the Client Automated Resource & Eligibility System (CARES) -- in order to ensure that such determinations are accurate and in compliance with all Federal and State regulations and policies. This process informs Directors of LDSS and LHDs, Family Investment Administration (FIA) central leadership at DHS, Medicaid administration at MDH, Maryland legislative leadership and Federal administration in the Center for Medicare and Medicaid Services (CMS), about the accuracy and timeliness of benefits processing. In addition, this position will be responsible for identifying corrective action (such as systems enhancements, training needs, or recommendations for policy changes) to prevent future errors.

MINIMUM QUALIFICATIONS

Education: A Bachelor's degree from an accredited college or university.

Experience: Three years of administrative or professional experience developing or applying policies and regulations in medical assistance, health insurance, federal or State entitlement programs.

Note:

1.  Additional administrative or professional experience applying policies and regulations in medical assistance, health insurance, federal or State entitlement programs or in a health or human service program may be substituted on a year-for-year basis for the required education.

2.  A Master's degree in the related field of work can be substituted for the required experience.

3. Candidates may substitute U.S. Armed Forces military service experience as a commissioned officer in Operational Analyst classifications or Health Services Management specialty codes in the health related field of work on a year-for-year basis for the required experience and education.

DESIRED OR PREFERRED QUALIFICATIONS

The desired applicant should have:

  • recent experience in determining eligibility for Medicaid programs or supervision of case managers who determined eligibility
  • expert knowledge of the policies and procedures related to the determination of eligibility for the State Medicaid Program
  • knowledge of the Affordable Care Act
  • detailed knowledge of systems and databases that are used to determine eligibility, access information about benefit applicants and recipients and verify their household circumstances
  • detailed knowledge of review procedures and policies as dictated by Federal and State guidelines

Selection Plan

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. 

Incorrect application forms will not be accepted. Resumes will not be accepted in lieu of a completed application.

Candidates may remain on the certified eligible list for a period of at least one year. The resulting certified eligible list for this recruitment may be used for similar positions in this or other State agencies.

LICENSES, REGISTRATIONS AND CERTIFICATIONS

Employees in this classification may be assigned duties which require the operation of a motor vehicle. Employees assigned such duties may be required to possess a motor vehicle operator's license valid in the State of Maryland.

BENEFITS

FURTHER INSTRUCTIONS

Online applications are highly recommended. However, if you are unable to apply online, the paper application (and supplemental questionnaire) may be submitted to MDH, Recruitment and Selection Division, 201 W. Preston St., Room 114-B, Baltimore, MD 21201. Paper application materials must be received by 5 pm, close of business, on the closing date for the recruitment, no postmarks will be accepted.

If additional information is required, the preferred method is to upload.  If you are unable to upload, please fax the requested information 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.

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.

We thank our Veterans for their service to our country.

People with disabilities and bilingual candidates are encouraged to apply.

As an equal opportunity employer, Maryland is committed to recruitment, retaining and promoting employees who are reflective of the State's diversity.