ADMINISTRATOR IV

This is a Management Service position, and serves at the pleasure of the Appointing Authority.

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The main purpose of a Unit Manager for Escalated Cases and Special Projects is to analyze, research and develop policies and procedures for Maryland Health Benefit Exchange Appeals and Grievance and Escalated Cases Unit. This position acts as a policy specialist for Medicaid and the Affordable Care Act and assists with trainings for other departments within Maryland Health Benefit Exchange. This position will also provide critical feedback and recommendations to the Manger of the Appeals and Grievance, Executive Team, Legislators for Maryland and Escalated Cases Unit, through written reports, presentations, emails, data reporting, trainings and verbal communications. The position also provides a high level review and correction recommendations for technical errors in HBX and Salesforce.

• Analyzes healthcare data and give recommendations on critical high level recommendations to Executive Team. Technical expert consultant to Executive Team, Appeals and Grievances, Office of Attorney General/OAG and Program Manager III for the Appeals and Grievance and Escalated Cases Unit.
• Analyze pertinent facts against appropriate State and Federal regulatory and policy provisions, and develop written recommendations to management.
• Prepare written reports analyzing alternatives and consequences, specifying findings and recommendations for management action, strategy, policy determinations and process changes. 
• Provide extensive interpretation of state and federal eligibility statutes, regulations, policies and guidelines to the administrative vendor, enrolled subscribers and the general public. 
• Works with the IT department on system resolutions and fixes for Qualified Health Plans and Medicaid policy.
• Comprehend and interpret data for Healthcare reports and performing qualitative analysis. Serves as an expert consultant and technical advisor on strategic health policy for MHBE.
• Interpreting healthcare policy for Appeals and Grievance and Escalated Cases Unit for MHBE.
• Draft and create enrollment data for Insurance Carriers for the State of Maryland. Liaison for Insurance Carrier Relations. 
• Provides correspondences to Legislators. 
• Assist Maryland Health Benefit Exchange staff interpret State and Federal policy. Expert consultant and Technical advisor for healthcare resolutions for Medicaid and qualify health plans through HBX.
• Special Projects Manager for the Maryland Health Benefit Exchange; Disenrollment, Exemptions, Deceased Report, Failure to Reconcile Report/ IRS report and mixed households' eligibility.   

Education: A Bachelor's degree from an accredited college or university.

Experience: Five years of experience in administrative staff or professional work. One year of this experience must have involved one or more of the following: the supervision of other employees, overseeing and coordinating the general operations of a unit, applying rules and regulations, or exercising responsibility for the development of policies or procedures.

Notes:

1. Additional experience in administrative staff or professional work may be substituted on a year-for-year basis for the required education.

2. Additional graduate level education at an accredited college or university may be substituted at the rate of 30 semester credit hours on a year-for-year basis for the required general experience.

3. Candidates may substitute U.S. Armed Forces military service experience as a commissioned officer involving staff work related to the administration of rules, regulations, policy, procedures and processes, or overseeing or coordinating unit operations or functioning as a staff assistant to a higher ranking commissioned officer on a year-for-year basis for the required education and experience.

This position is open to MHBE State employees only.

• Experience in an ACA, Medicaid, or other Caseworker specialist role
• Advanced experience, knowledge, and understanding of ACA & Medicaid - specifically researching, analyzing data, and policy & procedure development
• Knowledge, skills, and experience related to making recommendations to managers &directors through written reports, presentations, emails, data reporting, training, and verbal communications
• Experience working with or for a medical insurance carrier (including being highly familiar with the industry terminology and communication style)
• Proficient technical skills related to information systems including HBX, Salesforce, MMIS, Beacon, SVES, and/or other State information systems

Employees in this classification may be assigned duties which require the operation of a motor vehicle. Employees assigned such duties will be required to possess a motor vehicle operator's license valid in the State of Maryland.

Please make sure that you provide sufficient information on your application to show that you meet the qualifications for this recruitment. All information concerning your qualifications must be submitted by the closing date. We will not consider information submitted after this date. Successful candidates will be ranked as Best Qualified, Better Qualified, or Qualified and placed on the eligible (employment) list for at least one year.

The assessment may consist of a rating of your education, training, and experience related to the requirements of the position. It is important that you provide complete and accurate information on your application. Please report all experience and education that is related to this position.

STATE OF MARYLAND BENEFITS