08/01/1990 39650

MEDICAL ASSISTANCE PROGRAM TECHNICIAN SUPERVISOR

DEFINITION: This is technical supervisory and administrative work in the field of Medical Assistance.

An employee in this class supervises a group of Medical Assistance Program Technicians in the performance of a variety of para-technical, technical or administrative duties in support of the Medical Assistance Program. Work includes responsibility for the accuracy, completeness and timeliness of claims review and resolution, response to provider inquiries, enrollment of providers into the Medical Assistance Program, or a variety of operating procedures and processes in support of the Medical Assistance Program. Work also includes providing training for new employees and staff and conducting conferences and staff meetings. Work is performed in accordance with established policies and procedures under the direction of an administrative superior.

EXAMPLES OF WORK: Supervises staff engaged in the processing and resolution of claims; the provider inquiry process, the provider enrollment process, the claims payment process, third party liability determinations, prior authorization, or staff engaged in an operational segment of the Medical Assistance Program.

Distributes work assignments to assure effective utilization of staff and to maintain an acceptable level of accuracy and production; adapts work flow to accommodate emergency situations and peak work periods.

Reviews work of subordinate staff for completeness, accuracy and timeliness of action.

Provides technical assistance on complex or sensitive issues or situations.

Writes correspondence in response to inquiries to explain regulations, operational methods and administrative procedures or decisions.

Interprets program procedures, regulations, administrative processes and methods; informs staff of relevant changes; seeks clarification as necessary.

Participates in work groups and/or committees to provide relevant information for the development of new/revised procedures, processes or policies.

Trains and instructs beginning and journey level staff through individual or group methods on the programs, procedures and regulations of Medical Assistance.

Evaluates staff performance and makes recommendations regarding personnel actions.

Represents the Department at hearings providing testimony to defend decisions.

REQUIRED KNOWLEDGES, SKILLS, AND ABILITIES: Knowledge of the policies, rules, regulations, and procedures pertaining to the Medical Assistance Program.

Knowledge of the sources of available information on participating health care service providers and the methods and techniques used for explaining or clarifying policies and procedures relating to the proper application of costs and charges for authorized services provided by the different types of participating Medical Assistance Program service providers.

Knowledge of the types of participating health care service providers, such as hospitals, clinics, pharmacies, laboratories and medical practitioners, that are enrolled and are authorized for payment for services provided for eligible clients under the program.

Knowledge of the administrative processes and procedures for enrolling prospective service providers in the Medical Assistance Program or the processing of claims for payment for authorized services provided.

Knowledge of processing techniques and procedures relating to health care service insurance, service providers and delivery systems in such areas as medical records and billing/payment processes to ensure the proper application of allowable costs and charges for necessary and authorized services.

Ability to apply the basic principles and techniques of supervision such as assignment, review, and evaluation of the work of subordinates; and to train and instruct new employees in medical assistance regulations, procedures and administrative processes.

Ability to identify, interpret and apply medical assistance policies, procedures and regulations.

Ability to establish and maintain positive working relationships.

Ability to communicate effectively, both orally and in writing.

MINIMUM EXPERIENCE AND TRAINING: Two years of experience as a Medical Assistance Program Technician;

or

Any equivalent combination of experience and training.