|
Commonwealth of Pennsylvania |
|
|
POSITION DESCRIPTION FOR JOB POSTING |
|
|
Position Number: 00287678 |
Description Activated On: 2/6/2026 11:52:29 AM |
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. Responsible to determine cost effectiveness and enroll cost effective applicants into the HIPP Program. Responsible to maintain all enrolled cases to assure continuing eligibility and respond to case inquiries. This position is located within the HIPP section, Division of Third Party Liability, Bureau of Program Integrity. |
|
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. Specific duties include, but are not limited to the following: 10% - Respond to telephone inquiries and written inquiries from various types of program service providers, County Assistance Offices, inter and intra departmental agencies, and interested others, explaining the administrative processes and procedures for participation in the HIPP Program, the enrollment processes, the cost effectiveness determination process and the claims and premium payment processes for the HIPP program service delivery. 20% Review, analyze and evaluate employer group health insurance policies and employee benefit booklets to determine exact insurance coverage available to Medical Assistance recipients. Analyze and compare insurance premiums for specified coverage against projected annual Managed Care rates; negotiate with employers, unions, and/or insurance carriers to resolve issues; and enrollment dates. Determine cost effectiveness of employer group health plans (EGHP) and enroll eligible MA recipients into cost effective employer group health insurance. 25% Maintain enrolled HIPP cases by performing scheduled cost effectiveness re-evaluations. Respond to information obtained from change report forms and phone calls. Resolving HIPP status code reports; and other functions deemed necessary to assure that enrolled cases are properly maintained. Adjudicate overpayment/returned or undelivered checks. Develop and document detailed records for those cases determined no longer cost effective, and generate notices of discontinuance to recipients, employers, and County Assistance Offices. 5% Maintain a working knowledge of state and federal health insurance regulations as well as commercial insurance procedures. 10% - Contact employers of recipients enrolled in the Department’s Medical Assistance for Workers with Disabilities (MAWD) Program and arrange for MAWD Payments to be sent to the Department. Determine whether MAWD recipients are eligible for employer group health plans (EHGP); determine cost effectiveness of private insurance; negotiate to enroll qualified MAWD recipients in HIPP. 10% - Process Breast and Cervical Cancer Prevention and Treatment (BCCPT) referrals from the County Assistance Offices to determine credible coverage as defined by HIPAA regulations. Respond to BCCPT referral forms within five working days of receipt. 5% - Aid in the development and implementation of plans and procedures for HIPP operation activities. These may include routine office activities such as opening mail and routing correspondence or prepare letters, memos, etc. for routing and/or training. 5% - Maintain a working knowledge of the personal computer and the HIPP/MAWD/Fiscal databases, and the Department’s Client Information System (CIS). 5% - Work with other units within Third Party Liability and the HIPP Program and other Departmental agencies to facilitate an efficient and cost effective HIPP Program. 5% - Attend meetings, seminars, training, and perform other related duties |
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. Provides appropriate response to client inquires, based on Medical Assistance eligibility, employment status, and benefit information. Reviews policy benefits and deductibles to determine whether the policy would be appropriate for HIPP enrollments. Determines HIPP payment method based on discussions with employer and client. Resolves issues related to the proper posting of HIPP resources to the Department’s eligibility database and TPL database. Identifies and resolves issues related to HIPP overpayments, including the amount of overpayment and any savings adjustment appropriate for HIPP. Responds to requests from OIM caseworkers to determine credible coverage, as defined by HIPAA regulations, for clients enrolling in BCCPT enrollment. Researches availability of employer group insurance for persons enrolled in MAWD to determine whether these clients could be in HIPP. |
||||||||||||||||||||
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. |
||||||||||||||||||||
Essential Functions: Provide a list of essential functions for this position. Example: Transports boxes weighing up to 60 pounds.
|