PAY GRADE: 015
CLASS TITLE:HUMAN SERVICES PROGRAM RECORDS ANALYST
ALLOCATION FACTOR(S)
This is work investigating the delivery of services and costs in the use of Medicaid funds for health care or reviewing and analyzing case records to control and evaluate the quality and accuracy of processed claims.
EXAMPLES OF WORK PERFORMED:
(Note: The examples of work as listed in this class specification are not necessarily descriptive of any one position in the class. The omission of specific statements does not preclude management from assigning specific duties not listed herein if such duties are a logical assignment to the position. Examples of work performed are not to be used for allocation purposes.)
- Conducts field investigations of medical care services actually rendered as compared with the billing of services.
- Conducts workshops for agency staff and providers of services in Medicaid billing procedures.
- Reviews, analyzes and evaluates information contained in a statistically reliable sample of district case records for each element of program eligibility determination.
- Conducts field investigations which include personal interviews with the recipients to secure statements and verify evidence for each element of eligibility.
- Conducts interviews to secure supporting information to establish eligibility for programs.
- Prepares technical and analytical reports on investigative findings identifying specific causes of errors in recipient eligibility and implements corrective action to reduce incidences of errors.
- Performs related work as required.
KNOWLEDGE, SKILLS AND ABILITIES:
(Note: The knowledge, skills and abilities (KSA's) identified in this class specification represent those needed to perform the duties of this class. Additional knowledge, skills and abilities may be applicable for individual positions in the employing agency.)
- Knowledge of methods of compiling, organizing and analyzing data.
- Ability to conduct fact-finding interviews.
- Ability to conduct interviews
- Ability to compile, organize and analyze data.
- Ability to prepare technical and analytical reports.
- Ability to provide instruction to others.
- Ability to plan, organize and coordinate work assignments.
- Ability to communicate effectively.
- Ability to establish and maintain effective working relationships with others.
MINIMUM QUALIFICATIONS
- A bachelor's degree from an accredited college or university.
- Professional or nonprofessional experience social, economic, health or rehabilitative programs or in health insurance can substitute on a year-for-year basis for the required college education.
EFFECTIVE:
5/8/1996
HISTORY:
10/18/1994
01/01/1984