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MEDICAL SERVICES REPRESENTATIVE

The Medical Services Representative is responsible for applying regulations and procedures to determine applicants’ eligibility under the Medicaid Eligibility Program. This position is governed

Class Code:

C013C

Job Grade:

GS06

Special Job Requirements:

None

Typical Functions:

Interviews and screens people of diverse socio-economic backgrounds and temperaments for eligibility under the Medicaid Eligibility Program. Elicits information from applicants, regarding their financial status, resources, and obligations. Determines eligibility for the program, in accordance with department policies and procedures. Verifies and records eligibility data in case files using a computer equipped with program software, and reviews documentation for accuracy, completeness, and consistency. Determines share of cost responsibility of applicants based on their income and explains this responsibility, as well as ways to meet these obligations. Explains program requirements and regulations to applicants, health care providers, staff of community agencies, and the public. Evaluates patients for Medicaid eligibility and refers them, when appropriate, to the Division of Medical Services. Works closely with utilization review and social services staff to ensure that patients are appropriately directed to other assistance programs for which they are eligible. Screens non-Medicaid eligible patients referred by clinic or reception staff for potential eligibility for other assistance programs and makes referrals as appropriate. Performs other duties as assigned.

Knowledge, Abilities, and Skills:

Knowledge of Medicaid program policies, procedures, and operations. Knowledge of state and federal laws governing Medicaid programs. Knowledge of medical terminology and medical professional coding Knowledge of the principles and practices of human resources and organizational management. Ability to manage and organize program activities and direct operations through subordinates. Ability to and prepare oral and written reports.

Minimum Qualifications:

The formal education equivalent of a bachelor’s degree in business administration, human services, or related field; plus one year of experience in social service programs or a related area. Additional requirements determined by the agency for recruiting purposes require review and approval by the Office of Personnel Management. OTHER JOB RELATED EDUCATION AND/OR EXPERIENCE MAY BE SUBSTITUTED FOR ALL OR PART OF THESE BASIC REQUIREMENTS, EXCEPT FOR CERTIFICATION OR LICENSURE REQUIREMENTS, UPON APPROVAL OF THE QUALIFICATIONS REVIEW COMMITTEE.

Required Certificates:

None

Exempt:

N
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