POSITION DESCRIPTION

Transcription

1 State of Michigan Civil Service Commission Capitol Commons Center, P.O. Box Lansing, MI Position Code 1. DEPTALTE POSITIO DESCRIPTIO This position description serves as the official classification document of record for this position. Please complete the information as accurately as you can as the position description is used to determine the proper classification of the position. 2. Employee's ame (Last, First, M.I.) 8. Department/Agency MDHHS-COM HEALTH CETRAL OFF 3. Employee Identification umber 9. Bureau (Institution, Board, or Commission) Medicaid Operations and Actuarial Services 4. Civil Service Position Code Description 10. Division Departmental Analyst-E 5. Working Title (What the agency calls the position) 11. Section Managed Care Systems Operations Analyst Managed Care Data and System Support Section 6. ame and Position Code Description of Direct Supervisor 12. Unit WOLF, SAMATHA K; STATE ADMIISTRATIVE MAAGER-1 7. ame and Position Code Description of Second Level Supervisor 13. Work Location (City and Address)/Hours of Work KEISLIG, BRIA L; STATE BUREAU ADMIISTRATOR S. Pine, Capitol Commons / Monday - Friday General Summary of Function/Purpose of Position This position will serve as the analyst responsible with assisting staff to develop, maintain and analyze reports for the Managed Care System Operations section; as well as responding to Federal and State audits. The analyst will generate appropriate payments manually for MCR s and other payments requested via service request. The individual in this position will also assist contract managers with researching missing payments and the eligibility of members. The position will complete User Acceptability Testing and validiation for upcomming CHAMPS releases. Lastly, this position will assist with analyzing on-going section operations and provide recommendations and/or modifications to policies and procedures to achieve greater efficiency and effectiveness

2 15. Please describe the assigned duties, percent of time spent performing each duty, and what is done to complete each duty. List the duties from most important to least important. The total percentage of all duties performed must equal 100 percent.

3 Duty 1 Update and respond to Federal and State audit findings. Analyze existing and future audit findings for potential changes based on Federal and State regulations. Research available resources for possible options to improve the efficiency and effectiveness of the unit for responding as well as proactively addressing audits. Recommend modifications and updates as appropriate from the audit results. Use all available software and other tools to extract and analyze data from available sources including, but not limited to, CHAMPS, Bridges, Siebel/CRM, Excel, Access, and the data warehouse. Analyze encounters with specialist assistance proving detailed reports and feedback. Duty 2 Assist with gathering information for provider enrollment, enrolling providers into the system, and updating provider contact information in the CHAMPS system Work with team members to monitor provider enrollment information Update and maintain the provider screening collection tool Assist with Enrolling providers into the champs system Assist providers with enrollment of billing agents Assist other division s staff with enrollment of MCO/ Contractor providers Duty 3 Analyzing service request and generate payments when necessary. Research eligibility and enrollment to make the appropriate request for payment or enrollment changes On as-needed basis, assist department staff with researching missing payment transactions. Through the client relationship manager (CRM/Siebel) review and complete service request regularly. Research eligibility and enrollment of Medicaid members and apply the appropriate resolution. Work with Managed care organizations to explain denied payments Duty 4 Assist with User Acceptance Testing (UAT) of upcoming changes in CHAMPS. Assist section manager and other section staff in completion of UAT Test and validate reports as requested by management.

4 16. Describe the types of decisions made independently in this position and tell who or what is affected by those decisions. Self initiated as applicable to the position, work assignments, job priorities and work adjustments. With limited to no assistance make decisions on criteria/design/maintenance of procedures, processes and reports 17. Describe the types of decisions that require the supervisor's review. When issues arise that impact areas other than the specified assigned area of responsibility. 18. What kind of physical effort is used to perform this job? What environmental conditions in this position physically exposed to on the job? Indicate the amount of time and intensity of each activity and condition. Refer to instructions. Daily time seated at a desk or computer station. Limited travel may be required for regular work meetings. 19. List the names and position code descriptions of each classified employee whom this position immediately supervises or oversees on a fulltime, on-going basis. Additional Subordinates 20. This position's responsibilities for the above-listed employees includes the following (check as many as apply): Complete and sign service ratings. Assign work. Provide formal written counseling. Approve leave requests. Approve work. Review work. Approve time and attendance. Provide guidance on work methods. Orally reprimand. Train employees in the work. 22. Do you agree with the responses for items 1 through 20? If not, which items do you disagree with and why? Management Prepared 23. What are the essential functions of this position? This position will serve as Managed Care Systems Operations team member responsible for maintaining and analyzing reports for the Managed Care systems operations unit; as well as assisting with Federal and State regulated audit responses by providing detailed reports and feedback. The analyst trainee will also have primary responsibility for maintenance of service request sent to the section through the Client relationship Manager (CRM/Seibel). The postion will assist with manual payment tranasactioins, enrollment of providers, and data collection 24. Indicate specifically how the position's duties and responsibilities have changed since the position was last reviewed. ew 25. What is the function of the work area and how does this position fit into that function? The section is responsible for tracking and monitoring the managed care enrollment/disenrollment of beneficiaries into Medicaid Health Plans and other managed care programs across the Department; administering programmatic responsibilities related to enrollment and disenrollment for beneficiaries into managed care programs on a statewide basis, providing system support for all managed care programs across the Department for the HIPAA 834 and HIPAA 820 enrollment and payment transactions, maintaining and enhancing the CHAMPS system as needed to accomplish these goals and providing necessary data and reports to ensure ability to monitor, evaluation and continuously improve these functions. This position will serve as support in daily functions to the division 26. What are the minimum education and experience qualifications needed to perform the essential functions of this position. EDUCATIO: Possession of a bachelor s degree in any major. EXPERIECE:

5 Departmental Analyst 9 o specific type or amount is required. Departmental Analyst 10 One year of professional experience. Departmental Analyst P11 Two years of professional experience, including one year of experience equivalent to the intermediate (10) level in state service. KOWLEDGE, SKILLS, AD ABILITIES: Knowledge of computerized spreadsheets and database development and maintenance. Expertise in accessing and reading Bridges, CHAMPS, and Siebel/CRM Proficiency with software packages such as Excel and Word. Ability to communicate effectively, both verbally and in writing Attention to Detail Ability to work closely as a team CERTIFICATES, LICESES, REGISTRATIOS: ew OTE: Civil Service approval does not constitute agreement with or acceptance of the desired qualifications of this position. I certify that the information presented in this position description provides a complete and accurate depiction of the duties and responsibilities assigned to this position. Supervisor TO BE FILLED OUT BY APPOITIG AUTHORITY Indicate any exceptions or additions to the statements of employee or supervisors. /A I certify that the entries on these pages are accurate and complete. LORI LITTLE Appointing Authority 4/17/2017 I certify that the information presented in this position description provides a complete and accurate depiction of the duties and responsibilities assigned to this position. Employee