MEDICAID ANALYST 1

SS410 $33,405 - $60,112
Creation Date: 05/09/2001
Change Date: 01/01/2025

FUNCTION OF WORK:
To make initial and continuing determination, under close supervision, as to clients' eligibility for all Medicaid programs.

LEVEL OF WORK:
Entry

SUPERVISION RECEIVED:
Medicaid Analysts typically report to a Medicaid Analyst Supervisor. May receive supervision from higher level personnel.

SUPERVISION EXERCISED:
None.

JOB DISTINCTIONS:
Differs from Medicaid Analyst 2 by the presence of close supervision and the absence of independent action.

CORE COMPETENCIES:
IDENTIFIED BY STATE CIVIL SERVICE, CORE COMPETENCIES ARE THE KNOWLEDGE, SKILLS, ABILITIES AND BEHAVIORS BASED ON THE WORK TASKS OUTLINED IN THE EXAMPLES OF WORK. MORE INFORMATION ON THE SCS COMPETENCY MODEL CAN BE FOUND HERE.

Focusing on Customers	Following Policies and Procedures	Learning Actively
Making Accurate Judgments	Thinking Critically	Using Data

EXAMPLES OF WORK:
EXAMPLES BELOW ARE A BRIEF SAMPLE OF COMMON DUTIES ASSOCIATED WITH THIS JOB TITLE. NOT ALL POSSIBLE TASKS ARE INCLUDED.

Under close supervision, the entry level Medicaid Analyst learns to perform the following duties:

Conducts interviews with clients and makes other necessary collateral contacts for verification in determining eligibility for Medicaid Programs.

Examines application packets for timeliness, completeness, and appropriateness prior to authorization of reimbursement.

Makes decisions on complex eligibility factors and determines level of benefits for federal and state funded programs as a result of the rolldown procedure.

Interprets and applies complex federal, state, and agency policies for each program.

Conducts special investigations and compiles reports concerning fraud and location of absent parents.

Counsels and refers potentially eligible recipients or applicants to other agencies.

Contacts individuals, companies, businesses, local, state and federal agencies as needed to obtain or to verify information.

Records findings, recommendations, and services provided; completes case record forms and necessary correspondence in connection with assigned cases.

QUALIFICATION REQUIREMENTS:
MINIMUM QUALIFICATIONS:
Three years of social services experience; OR

Six years of full-time experience in any field; OR

A bachelor's degree.

EXPERIENCE SUBSTITUTION:
Every 30 semester hours earned from an accredited college or university will be credited as one year of experience towards the six years of full-time work experience in any field. The maximum substitution allowed is 120 semester hours which substitutes for a maximum of four years of experience in any field.