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Commonwealth of Pennsylvania |
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POSITION DESCRIPTION FOR JOB POSTING |
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Position Number: 00074958 |
Description Activated On: 10/8/2026 1:40:35 PM |
Position Purpose: Describe the primary purpose of this position and how it contributes to the organization’s objectives. Example: Provides clerical and office support within the Division to ensure its operations are conducted efficiently and effectively. This position is located in the Statement of Claim (SOC) Creation Unit, Recovery Section, Division of Third Party Liability, Bureau of Program Integrity, Office of Administration. The incumbent in this position is responsible for supervising the Medical Assistance Program Technician staff. This employee oversees all the work completed by the MA Program Techs to include; reviewing, analyzing and computing all medical, cash and decedent statements of claim for which the department is seeking a recovery. |
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Description of Duties: Describe in detail the duties and responsibilities assigned to this position. Descriptions should include the major end result of the task. Example: Types correspondence, reports, and other various documents from handwritten drafts for review and signature of the supervisor. Responsible for the hiring, training, and providing of guidance for the MA Program Techs assigned to TPL’s SOC Creation Unit. Training includes instructing MA Program Techs on how to review and perform complex work that involves the decoding, interpretation and analytical explanation of cash and/or medical assistance claims to determine if they should be recovered. This includes using the appropriate medical procedures, drugs, as well as any long term care or waiver services for estates, and follow-up care relating to a specific accident injury or estate in which the Department of Human Services is seeking repayment. Training new MA Program Tech staff to review and calculate debit and credit adjustments to long term care claims through hospital co-payments; private/patient pay from recipients; to post an accurate estimated dollar figure to be used on the statement of claim given to the Agents/Investigators for recovery from the recipient’s estate. Provides guidance on TPL policies and procedures both general and job specific. Provides administrative support regarding time and attendance issues, and writing performance ratings for TPL SOC Creation Unit’s MA Program Techs. Evaluates staff performance and makes recommendations regarding personnel actions. Assigns and tracks requests that have a higher priority (Ex. Urgent cases must be given immediate attention) to ensure they are completed timely and also equitably assigned to the MA Program Techs working in the unit. Determines what the MA Program Techs should be focusing on during regular work hours, as well as any scheduled overtime, and assigns work accordingly. Coordinates the sending of requests (to determine if child support payments have been received on behalf of a recipient) to PACSES and receiving and posting the results of the file to the shared drive for the MA Program Techs to finalize a SOC awaiting the requested information. Assists to clarify any questions or discrepancies on PACSES data for the MA Program Techs. This position ensures that the MA Program Techs properly research PACSES, calculate, update and post appropriate cash assistance claims and credits using the correct liability standard and allowing for applicable credits and debits via child care, child support and/or spousal support and special allowances permitted by federal law. Represent the MA Program Techs for any communication between/with other supervisors within TPL and also any outside sources. Has familiarity with reviewing and interpreting complex client encounter data. If encounter data is submitted in different formats from managed care organizations, then provides staff with details of each plans format to explain the fiscal processes used to arrive at the statement of claim amount due and owing to the Commonwealth. Has a complete understanding of Medical Assistance Program and Federal regulations needed to do the preparation and completion of the statements of claim. Provides guidance to MA Program Techs regarding analyzing and applying governmental regulations and policies for computing Estate and Casualty recovery statements of claim, including making complex and independent decisions in determining the proper claims and cash to be included. Provides statistics to management for tracking statements of claim backlogs and management reports. Acts as the representative for the MA Program Techs regarding any queries or issues relating to work completed by the unit. Performs other related duties as required |
Decision Making: Describe the types of decisions made by the incumbent of this position and the types of decisions referred to others. Identify the problems or issues that can be resolved at the level of this position, versus those that must be referred to the supervisor. Example: In response to a customer inquiry, this work involves researching the status of an activity and preparing a formal response for the supervisor’s signature. Responsible for interpreting Federal and State laws, regulations and policies as it relates to computation of statement of claims. Responsible for providing guidance to staff relating to decisions in the computation of the Statement of Claims. |
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Requirements Profile: Identify any specific experience or requirements, such as a licensure, registration, or certification, which may be necessary to perform the functions of the position. Position-specific requirements should be consistent with a Special Requirement or other criteria identified in the classification specification covering this position. Example: Experience using Java; Professional Engineer License Experience: Licenses, registrations, or certifications: 1. N/A 2. N/A 3. N/A 4. 5. 6. |
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Essential Functions: Provide a list of essential functions for this position. Example: Transports boxes weighing up to 60 pounds.
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