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MEDICAL CARE PROGRAM SPECIALIST II

FULL-TIME CONTRACTUAL

Recruitment #15-000928-0005

GRADE

15

LOCATION OF POSITION

Department of Health and Mental Hygiene

Office of the Inspector General

201 W. Preston Street

Baltimore, MD  21201

Main Purpose of Job

The Contractual Medical Care Program Specialist II at the full performance level complying with all applicable State and Federal law and regulations in its billing practices with the intended purpose of preventing fraud, waste and abuse of departmental funds. This position ensures that violations of Medicaid resources expended through Medicaid programs and services are investigated in accordance with the Affordable Care Act, State and Federal laws, regulations and policies. The administrative, investigative, auditing and recovery functions of this position operate within the Fraud Detection and Determination Unit (FDDU) and significantly contribute to the Office of the Inspector General's (OIG) recoveries and cost avoidance savings of more than $20 million annually. This position is responsible for the review of Maryland Medical Assistance (MA) cases randomly selected for the federally mandated Payment Error Rate Measurement (PERM) program. The main purpose of this position is to conduct independent and self-directed investigations regarding recipient fraud, waste and abuse for the MA program, and to determine the accuracy of the Medicaid eligibility determinations through review, investigation, analysis and reporting of eligibility findings. These specific and unique duties are frequently of a confidential and sensitive nature and are conducted in accordance with The Health Insurances Portability and Accountability Act of 1996 (HIPPA) and COMAR 10.09.24 and 10.09.36. This position ensures that private health information entrusted to the department is appropriately protected from disclosure.  Each audit, investigation or inspection results in a report with recommendations which may include, license revocation, recoveries, and or civil money prosecutions.

MINIMUM QUALIFICATIONS

Education:    A Bachelor's degree from an accredited college or university.

Experience:  Three years of administrative or professional experience developing or applying policies and regulations in medical assistance, health insurance, federal or State entitlement programs.

NOTE:

1.  Additional administrative or professional experience applying policies and regulations in medical assistance, health insurance, federal or State entitlement programs or in a health or human service program may be substituted on a year-for-year basis for the required education.

2.  A Master's degree in the related field of work can be substituted for the required experience.

3.  Candidates may substitute U.S. Armed Forces military service experience as a commissioned officer in Operational Analyst classifications or Health Services Management specialty codes in the health related field of work on a year-for-year basis for the required experience and education.

DESIRED OR PREFERRED QUALIFICATIONS

The desirable candidate should have a working knowledge of current State and Federal Medicaid Eligibility requirements and categories. The incumbent should be able to apply these requirements to record reviews and be able to determine Medicaid eligibility for an individual or family. The incumbent should have training and a a working knowledge of the Medicaid Management Information System (MMIS), Client Automated Resource Eligibility System (CARES) and the Maryland Health Benefit Exchange (HBX).  The employee should be familiar with record reviews and acceptable documents necessary for appropriate eligibility determinations with one year of experience involving Medicaid eligibility determinations. 

LICENSES, REGISTRATIONS AND CERTIFICATIONS

Employees in this classification may be assigned duties which require the operation of a motor vehicle. Employees assigned such duties may be required to possess a motor vehicle operator's license valid in the State of Maryland.

SELECTION PROCESS

Applicants who meet the minimum qualifications will be evaluated. The evaluation may be a rating of your application based on your education, training and experience as they relate to the requirements of the position. Therefore, it is essential that you provide complete and accurate information on your application. Please report all related education, experience, dates and hours of work. For education obtained outside the U.S., a copy of the equivalent American education as determined by a foreign credential evaluation service must accompany the application. All information concerning your qualifications must be submitted by the closing date. We will not consider information submitted after this date. For Recorded Job Information Call: 410-767-6018.

BENEFITS

FURTHER INSTRUCTIONS

Online application process is STRONGLY preferred. If online process is not available, please send your paper application to: DHMH, Recruitment and Selection Division, 201 W. Preston St., Room 114-B, Baltimore, MD 21201. The paper application must be received by 5 pm, close of business, on the closing date for the recruitment, no postmarks will be accepted.

Incorrect application forms will not be accepted.

If you need to submit additional information, the preferred method is to upload. If unable to upload, please fax requested information only to 410-333-5689.

Appropriate accommodations for individuals with disabilities are available upon request by calling: (410) 767-1251 or MD TTY Relay Service 1-800-735-2258.

We thank our Veterans for their service to our country, and encourage them to apply.

As an equal opportunity employer Maryland is committed to recruiting, retaining and promoting employees who are reflective of the State’s diversity.




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