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Medicaid Coordinator 1 Jurisdiction: Schuyler County Jurisdictional Class: Adopted: November 15, 2006 ; Reviewed: July 5, 2011 MEDICAID COORDINATOR DISTINGUISHING FEATURES OF THE CLASS: The work involves responsibility for directing the activities of the Medicaid Programs in the Department of Social Services. The incumbent acts as liaison for Managed Care programs, and also manages the work of the Medicaid Unit. The work is performed under the general direction of the Commissioner of Social Services, with supervision exercised over Senior Social Welfare Examiners, Social Welfare Examiners, and clerical staff. Does related work as required. TYPICAL WORK ACTIVITIES: Supervises and reviews eligibility determinations, budgets and calculations, and consults with subordinate workers for purposes of final determination and eligibility; Establishes necessary controls for determining staff performance and makes necessary performance evaluation; Plans, directs and manages the unit activities and supervises assigned staff; Participates in the formulation of local policies and procedures that relate to eligibility for the programs administered by the local Social Service district; Evaluates current and proposed policies and procedures for appropriateness; Evaluates applications and conducts interviews for new department employees as well as facilitates employee training; Performs check of statewide computer system to monitor for double registration of clients as well as consulting with other agencies and community groups; Makes an evaluation of client’s eligibility for assistance, may determine initial categorical eligibility and evaluates available resource details in relation to eligibility; Reviews employee time cards for accuracy and approves leave requests; Refers clients, when appropriate, to specialists, such as medical support services; Appears at administrative/judicial proceedings if required to interpret decisions on applications; Reports findings of investigations and makes recommendations for proper disposition of cases; Presents various outreach programs and promotes public relations, such as by presenting information to community agencies, groups, etc.; Attends continuing education training, workshops and other related meetings regarding new or existing State/Federal laws/mandates/programs as well as meetings concerning local programs; Oversees and manages the Department’s Medicaid Managed Care Program, to include acting as liaison with the program’s administrator; Reviews worker’s cases to ensure compliance with applicable rules and regulations; Manages the Medicaid transportation program as well as the County burial program; Compiles & submits required reports, such as those related to both client or provider population; Reviews client and provider profiles for the purpose of identifying unusual utilization patterns; Monitors, evaluates and modifies client education and awareness of Medicaid and managed care programs, and assists in the implementation of efficient recruitment and/or enrollment; Interacts with client and provider populations to resolve problems in approving Medicaid cases; ---PAGE BREAK--- Medicaid Coordinator 2 Monitors client grievances and may act as liaison to resolve clients’ complaints against medical providers. FULL PERFORMANCE KNOWLEDGE, SKILLS, ABILITIES, AND PERSONAL CHARACTERISTICS: Thorough knowledge of Federal, State and local social services laws and programs as they affect eligibility; Good knowledge of Managed Care and the County’s medical community; Good knowledge of the agency’s overall programs, policies, and procedures and their impact on Medicaid recipients; Good knowledge of other laws and regulations as they affect eligibility, such as Workers’ Compensation, Social Security and Unemployment Insurance; Ability to plan, organize and supervise the work of others; Ability to deal effectively and establish and maintain successful relationships with people; Ability to read, interpret and apply complex written material to specific situations; Ability to analyze facts and use them in making sound decisions regarding eligibility or other decisions; Ability to prepare clear and accurate records and reports and communicate clearly both orally and in writing; Ability to use a computer for word processing and other programs or applications, such as for the entry and retrieval of information in a database or on spreadsheets, etc.; Ability to plan and implement action plans to effectively address the needs of clients and agency; Ability to understand and follow directions; Initiative and good judgment; Physical condition commensurate with the demands of the position. MINIMUM QUALIFICATIONS: Either: A. Completion of two years (60 semester credit hours) of study in a regionally accredited college or university or one accredited by the New York State Board of Regents to grant degrees and three years of experience in examining, investigating or evaluating claims for assistance, veterans or unemployment insurance benefits, or similar program operating under established criteria for eligibility; or B. Graduation from high school or possession of a high school equivalency diploma and five years of experience as outlined in above; or C. An equivalent combination of training and experience as defined by the limits of and above.