MEDICAID PROGRAM SPECIALIST 1

AS613 $37,523 - $73,632
Creation Date: 08/29/2005
Change Date: 01/01/2025

FUNCTION OF WORK:
To perform research and analysis related to Medicaid programs.

LEVEL OF WORK:
Entry

SUPERVISION RECEIVED:
Close from a Medicaid Program Supervisor or above.

SUPERVISION EXERCISED:
None.

JOB DISTINCTIONS:
Differs from Medicaid Program Specialist 2 by the close supervision received 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.

Communicating Effectively	Demonstrating Accountability	Focusing on Customers
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:
Participates in on-the-job training program, which involves rotation from project to project training in various program areas.

Researches, analyzes and compiles data for various reports.

Provides assistance in response to inquiries from the general public and public officials relative to Medicaid eligibility, payments, policy and procedures.

Reviews and analyzes data for corrective action, fiscal impact, etc.

Updates and monitors system databases.

Maintains records, prepares reports and conducts correspondence relative to the program element assigned.

Researches and analyzes provider billing practices via complex system reports and/or on site visits and recommends sanctions in accordance with state and federal regulations.

Consults with Information Technology staff to assure policy is correctly reflected by system programming.

QUALIFICATION REQUIREMENTS:
MINIMUM QUALIFICATIONS:
Three years of experience in research and analysis related to Medicaid programs; public health, public relations, social services, health services, or administrative services; OR

Six years of full-time work 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.