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Commonwealth of Pennsylvania |
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POSITION DESCRIPTION FOR JOB POSTING |
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Position Number: 50703044 |
Description Activated On: 3/24/2026 1:35:26 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 in the Office of Mental Health and Substance Abuse Services (OMHSAS), Bureau of Quality Management and Data Review (BQMDR), Division of Systems Management, Systems Operation Section, Business Partner Support Unit. Using proven methodologies and evidence-based practices, BQMDR works to ensure that adults and children with mental illness and/or substance use disorders, and their families, receive high-quality services from the Department of Human Services (DHS). The Business Partner Support Unit serves as the primary liaison between Managed Care Operations and external stakeholders, including Managed Care Organizations and providers. The unit ensures accurate and compliant enrollment and disenrollment processing, provides technical assistance and policy guidance, and supports system and operational improvements to maintain the integrity and effectiveness of the Behavioral Health HealthChoices program. |
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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. This position serves as a Human Service Analyst responsible for the analysis and administration of Managed Care enrollment and disenrollment processes within the Business Partner Support Unit, with primary responsibility for Behavioral Health HealthChoices enrollment activities in eCIS. Receiving and processing electronic enrollment and disenrollment requests from Managed Care Organizations (MCOs) and Primary Contractors in accordance with Behavioral Health HealthChoices contractual requirements. Analyzing and evaluating recipient cases in the electronic Client Information System (eCIS) to determine appropriate enrollment, disenrollment, or coverage corrections. Notifying County Assistance Offices (CAOs) of required Medical Assistance eligibility updates or facility/waiver code changes to ensure proper coverage alignment. Reviewing system output reports to identify recipients requiring evaluation for potential disenrollment and taking appropriate action. Interpreting and applying Department policy, contract requirements, and Appendix V to ensure enrollment processes remain compliant. Reviewing and analyzing policy changes and assisting in developing procedures to implement policy decisions. Evaluating the impact of program initiatives on Managed Care processing logic and recommending procedural or systems changes. Researching and resolving enrollment-related issues, including online and batch processing concerns in eCIS. Developing and analyzing enrollment data to identify trends and support management decision-making. Providing technical assistance to MCOs, providers, and internal staff regarding enrollment processes and system functionality. Participating in meetings and workgroups related to Managed Care policy and operational processes. Preparing reports, queries, and correspondence using MS Office and other applications. Providing training and backup support within the division, as needed. Performing other duties as assigned. |
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 assisting in the making of decisions that impact policy, procedures, operational processes, or contract provisions or standards related to health care operations or MCOs. Responsible for formulating a conclusion or recommendation for the supervisor’s approval based on thorough research and review of documents and reports. Responsible for managing priority items and communicating any potential barriers to completion of other work items to the supervisor. Responsible for working independently to ensure efficient and effective day-to-day operations, obtaining supervisory guidance on the most complex, sensitive, or precedent-setting issues. Responsible for understanding what situations require supervisor involvement/approval for completion. |
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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. N/A 5. N/A 6. N/A |
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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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