MEDICAID LTC ANALYST 1

SS411 $35,734 - $64,314
Creation Date: 11/30/2020
Change Date: 01/01/2025

FUNCTION OF WORK:
To perform initial determination of eligibility and ongoing case management for the Medicaid Long-Term Care program.

LEVEL OF WORK:
Entry

SUPERVISION RECEIVED:
Direct from a Medicaid LTC Supervisor. Other reporting relationships may be approved by SCS.

SUPERVISION EXERCISED:
None.

JOB DISTINCTIONS:
Differs from Medicaid LTC Analyst 2 by the absence of experienced-level eligibility and case management responsibilities.

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.

Accepting Direction

Learning Actively

Thinking Critically

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

Learns to determine financial and medical eligibility for Medicaid programs for individuals in Long-Term Care who are institutionalized either in a facility or at home.

Learns to interpret and apply complex federal, state, and agency policies to long-term care eligibility requirements.

Learns to evaluate financial and medical documentation to determine if the applicant is eligible for institutionalized services.

Acquires skill in the review of all case documentation, resolves discrepancies in financial eligibility and medical evidence from other agencies, and makes efforts to obtain required documentation and request additional documentation.

Learns to schedule interviews with applicants, representatives, and facilities to determine eligibility for Medicaid Long-Term Care programs.

Trains in the analysis of all sources of information related to provider forms and medical certifications when needed. Learns to determine if the medical certifications are consistent with provider forms and eligibility and, if necessary, resolves those inconsistencies.

Learns to examine application packets for timeliness, completeness, and appropriateness prior to authorization.

Learns to consult with internal and external professionals including advocacy groups, attorneys, providers, nursing facilities, corporate executives, and financial institutions. Considers hardships and penalty periods when making determinations.

Learns to determine and reconcile recipient financial liabilities to providers. Learns to determine and reconcile incurred medical expenses and other deductions that may impact financial liability.

May be assigned directly to providers or facilities.

QUALIFICATION REQUIREMENTS:
MINIMUM QUALIFICATIONS:
Three years of experience in eligibility determinations for long-term care programs; 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.