State of Maryland

A Purchased Care Supervisor I is the first level of supervisory work in the Medical Assistance Operations Administration involving responsibility as a lead worker in an operational unit.  Employees in this classification, as lead workers, assist the Purchased Care Supervisor II or other designated agency official by providing direction, guidance, and training to the subordinate staff.  Employees in this classification exercise discretion and some independent judgment in applying regulations and policies of the Program, as well as tact and diplomacy in dealing with Medical Assistance providers as well as other administrations and agencies having business with the Program.  Employees in this classification are responsible for reviewing and directing the work of a small number of subordinate staff.  Employees in this classification may assume responsibility for the operation of the unit in the absence of the supervisor.

Employees in this classification receive general supervision from a Purchased Care Supervisor II or other designated agency official.  Work is evaluated through observation and analysis of manually prepared or systems-generated reports in terms of production standards, quality, and transaction processing time.

Positions in this classification are evaluated by using the classification job evaluation methodology.  The use of this method involves comparing the assigned duties and responsibilities of a position to the job criteria found in the Nature of Work and Examples of Work sections of the class specification.

Assists the unit supervisor in planning, assigning, and reviewing the work of a group of employees performing clerical tasks in the Medical Assistance Program;

Assists providers and recipients in resolving problems involving invoice payment, eligibility, and procedures by means of correspondence, telephone conversations and personal contact;

Assists in the identification and resolution of problems which may require the exercise of independent action and the interpretation of established policies and procedures;

Makes recommendations for improvements or modifications of operations and procedures;

Reviews computer-generated reports to identify, document, and resolve potential problems;

Participates in training of subordinates in the proper use of cathode ray tubes and computer-generated documentation;

Acts as the unit supervisor in the absence of the supervisor;

Assists the coordinators of the various processing sections for special projects;

Performs other related duties.

Knowledge of modern office practices, procedures and equipment;

Knowledge of business English, spelling, punctuation, and grammar;

Knowledge of basic arithmetic;

Knowledge of office management and supervision of clerical activities;

Ability to understand complex automated systems such as claims processing, recipient eligibility or provider eligibility systems, including the ability to perform trouble-shooting tasks in the event of apparent system malfunction;

Ability to read, interpret and apply Medical Assistance regulations and guidelines in the processing of claims, enrollment of providers or recipients or other operational activities;

Ability to work independently on complex claims payment problems or other operational problems;

Ability to organize the workload of the unit for the purposes of controlling, processing and avoiding excessive backlogs;

Ability to control claims production in order to meet federal claims payment cycle time standards;

Ability to maintain harmonious working relationships with other employees, including clerical personnel, professional employees, and administrative officials.

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

Experience: Four years of experience performing fiscal-clerical or claims processing work in a health, government, insurance or other related work setting.

Notes:

1. Candidates may substitute additional education from an accredited college or university at the rate of 15 credits for six months of experience for up to three years of the required experience.

2. Candidates may substitute additional experience as defined above on a year-for-year basis for the required education.

Class specifications are broad descriptions covering groups of positions used by various State departments and agencies. Position descriptions maintained by the using department or agency specifically address the essential job functions of each position.

This is a Skilled Service classification in the State Personnel Management System.  All positions in this classification are Skilled Service positions.  Some positions in Skilled Service classifications may be designated Special Appointment in accordance with the State Personnel and Pensions Article, Section 6-405, Annotated Code of Maryland.

This classification is not assigned to a bargaining unit, as indicated by the designation of S (Supervisor), M (Manager), T (Agency Head), U (Board or Commission Member), W (Student), X (Used by Agency or Excluded by Executive Order), or Z (Confidential).  As provided by State Personnel and Pensions Article, Section 3-102, special appointment, temporary, contractual, supervisory, managerial and confidential employees are excluded from collective bargaining.  Additionally, certain executive branch agencies are exempt from collective bargaining and all positions in those agencies are excluded from collective bargaining.

Employees in this classification are eligible to receive overtime compensation.  An employee who works more than the normal workweek is entitled to be compensated for that overtime as provided by State Personnel and Pensions Article, Section 8-305.