MEDICAL CARE PROGRAM ASSOCIATE I

10

Department of Health and Mental Hygiene

Medical Care Programs

Office of Systems, Operations, and Pharmacy

201 W. Preston Street

Baltimore, MD  21201 

The main purpose of this position is to process medicaid claims in the Claims Processing Unit. The Claims Specialist/Processor is responsible for the accurate and timely front end adjudication of medical claims for fee for service inpatient, outpatient facility and professional services. Normal processing includes data entry of the claim, the review and interpretation benefits and edit/audit resolution, claim payment and routing claims for review to OHS for resolution. The employee will follow all state & federal regulations when determining responsible payer, coding of the claims and ensuring that clean claims are filed to each payer. This employee must have good interpersonal skills, the ability to complete correspondence and applicable forms to obtain information necessary for claim adjudication. Processing of some claims may require reviewing letters from physicians to determine payable procedures and or recipient/provider eligibility. This position has many changing processing procedures, provider/recipient eligibility determination and system modifications. The Specialist/Processor must process claims in an accurate and timely manner in order to meet state and federal requirements while maintaining acceptable performance levels based upon standards for production and quality. Other duties, responsibilities and qualifications may be required and/or assigned as necessary.

Education:    Graduation from an accredited high school or possession of a high school equivalency certificate.

Experience:  One year of clerical experience applying policies in a medical care, health insurance or federal or State entitlement program.

NOTES:

1.  Additional general clerical experience may be substituted on a year-for-year basis for the required education.

2.  Thirty credit hours from an accredited college or university may be substituted for the required experience.

None.

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.

CONTRACTUAL EMPLOYEE HEALTH BENEFITS

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.

Should additional information regarding this recruitment be required, please contact the DHMH Recruitment and Selection Division at 410-767-1251 or via email at dhmh.jobs@maryland.gov.