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MEDICAL CARE PROGRAM ASSOCIATE II

Recruitment #24-004395-0010

Introduction

GRADE

ASTD11

LOCATION OF POSITION

MDH - Division of Financial Services
201 W. Preston Street
Baltimore, MD 21201

Main Purpose of Job

The main purpose of this position is to recoup or pay and chase monies back to the State of Maryland from legally responsible third commercial insurances. This position will analyze medical assistance claims by collecting and reviewing information on individual claims and identifying if Medicaid is legally responsible or if commercial health coverage is liable for the payment of health care services. This position will compare data matches from various sources to confirm the accuracy of third-party liability coverage. The Medical Care Program Associate II will review and make recommendations regarding regulatory changes to the standard TPL collection procedures. This position must interpret and apply Federal and State regulations, (COMAR), daily relating to third party recovery of health insurance.

To ensure that the Maryland Department of Health is the last payer of resort it becomes necessary to access provider portals to determine the existing or terminated TPL online for AARP Supplemental & Personal Health Plan, CareFirst Direct including out of state BlueCross coverage, Availity, United Health Care, Human Military, NaviNet, United Medical Resource (UMR), US Health Group, and many internal systems such as CCU Portals and Maryland Health Exchange.

MINIMUM QUALIFICATIONS

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.

DESIRED OR PREFERRED QUALIFICATIONS

The desired candidate should possess the following:
  • Experience interpreting information to research and pursue sources to identify TPL health insurance coverage
  • Experience with third party liability claim processing and Maryland Medicaid Information System
  • Experience conducting investigations 
  • Experience communicating via telephone and email 
  • Experience multitasking and prioritizing cases according to the urgency of calls reported

SELECTION PROCESS

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.

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.



Click on a link below to apply for this position:

Fill out the Supplemental Questionnaire and Application NOW using the Internet. Apply Online
View and print the Supplemental Questionnaire. This recruitment requires completion of a supplemental questionnaire. You may view and print the supplemental questionnaire here.
Apply via Paper Application. You may also download and complete the Paper Application here.

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