174060
MEDICAID LTC SPECIALIST
SS415 $47,757 - $86,070
Creation Date: 11/30/2020
Change Date: 12/11/2025
FUNCTION OF WORK:To perform research and analysis, professional relations, and compliance duties for the Medicaid Long-Term Care program.
LEVEL OF WORK:SUPERVISION RECEIVED:Direct from a Medicaid LTC Supervisor. Other reporting relationships may be approved by SCS.
SUPERVISION EXERCISED:May exercise functional supervision over lower-level Medicaid LTC Analysts.
JOB DISTINCTIONS:Differs from Medicaid LTC Analyst 3 by the presence of professional relations and compliance responsibilities.
Differs from Medicaid LTC Supervisor by the absence of direct supervisory 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.
| Communicating Effectively | Demonstrating Accountability | 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.
Reviews a random sampling of cases for completion and accuracy to ensure that quality and program integrity are maintained.
Performs special studies, analyzes data, compiles reports, and completes projects as determined by administration. Researches, analyzes and compiles data for various reports.
Analyzes available federal performance data and makes comparisons to program performance to make recommendations for improvement to share through meetings or trainings.
Acts as liaison with the fiscal intermediary and Medicaid Eligibility Systems section in order to address recipient and provider service and payment discrepancies.
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. Receives reports and reconciles recipient eligibility and vendor payment eligibility segments.
Receives and handles inquiries from recipients and providers contacting the LTC Contact Center.
Conducts ongoing programmatic reviews to ensure compliance with federal and state regulations.
Consults with Information Technology staff to assure policy is correctly reflected by system programming.
QUALIFICATION REQUIREMENTS:MINIMUM QUALIFICATIONS:
Six years of experience in eligibility determinations for long-term care programs; OR
Six years of full-time experience in any field plus three years of experience in eligibility determinations for long-term care programs; OR
A bachelor's degree plus three years of experience in eligibility determinations for long-term care programs; OR
An advanced degree plus two years of experience in eligibility determinations for long-term care programs.
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.