Duty Statement, DHS 2388



duty statementClass Title:Staff Services AnalystPosition Number:805-253-5157-XXXUnit:Cost Avoidance UnitSection:Coordination of BenefitsBranch:Coordination of Benefits and Administration Division:Third Party Liability and Recovery Job Expectations This position requires the incumbent maintain consistent and regular attendance; communicate effectively orally and in writing in dealing with the public and/or other employees; develop and maintain knowledge and skill related to specific tasks, methodologies, materials, tools and equipment; complete assignments in a timely and efficient manner; and, adhere to departmental policies and procedures regarding protected health information, attendance, leave, and professional conduct. Adhere to the highest possible standards for performance and quality of work products; pay attention to details in written documents; and accuracy in presentation of data, statistics, and conclusions. Willingness and ability to accept increasing responsibility and changing work priorities.Job Summary: The Staff Services Analyst (SSA) performs a wide range of analytical and administrative tasks associated with the development, operation and ongoing monitoring of difficult issues concerning Medicaid and Medicare cost avoidance processes to ensure compliance with federal and state laws and regulations. The SSA is involved in a variety of assignments, for which they must be able to identify and evaluate problems in order to take the appropriate actions and resolve independently. Supervision Received: Under general supervision of the Staff Services Manager I, Chief, Cost Avoidance Unit.Supervision Exercised: None Description of Duties: The SSA is expected to consistently exercise initiative, independence, and innovation in performing assigned tasks for cost avoidance in the Coordination of Benefits Section (COBS). CAU is responsible for maintaining the Health Insurance Subsystem (HIS) of the Medi-Cal Eligibility Data System (MEDS), which contains other health coverage (OHC) information provided by commercial insurance carriers and Medicare, to Medi-Cal beneficiaries. Analysts in this unit identify, analyze, and/or resolve other health coverage issues presented using the HIS and Carrier Code Master File (CCMF) within MEDS. The SSA is responsible for preparing reports and recommendations to management regarding program improvements or procedural changes as needed. The incumbent must have effective interpersonal skills, strong verbal and written communication skills. The SSA assists in the development of, and engages in the planning, directing, testing, and training new staff in resolving questions related to the HIS Reconciliation Process. The SSA is responsible for ensuring all information is correct and up to date on the Cost Avoidance Unit webpage and its SharePoint site content. The SSA may interact with a wide range of programs within the Department as well as external stakeholders.Percent of Time Essential Functions 35%Review, research, evaluate and assist in the development of operational policies and procedures for efficiency and effectiveness of the Cost Avoidance Unit (CAU). Initiate and lead meetings with management and other employees to examine workflow processes to identify areas needing improvement. Work with management to plan and assist in the implementation of procedures or policy changes to ensure CAU’s operational functions are met and consistent with business needs. Provide feasibility reports and statistics on daily and/or monthly basis capturing trends and outliers. Assist in the development of methodology and models to gather statistical data for accurate cost benefit analysis of insurance carrier data matches. Train CAU employees when new procedures are established or as needed to adhere to existing procedures. 35%Verifies CAU’s daily operation by performing analysis to reconcile a Medi-Cal member’s Other Health Coverage (OHC) loaded into the Health Insurance System (HIS) is accurate by using the Carrier Code Master File (CCMF), Medi-Cal Eligibility Data System (MEDS), Outlook, Autoform application (online forms) and various resources. Provide recommendations to management regarding enhancements or procedural changes relating to CAU daily operations to produce processing efficiencies. The incumbent maintains access to care by confirming accurate medical coverage is presented in MEDS and ensuring deadlines are met. Independently identify, analyze, and/or resolve issues with HIS, CCMF, and MEDS. Generate and maintain data files that are transmitted to Enterprise Technology Services Division (ETS). Work with ETS on work requests to troubleshoot, reconcile, or improve the file match process with commercial insurance carriers to ensure accurate reporting of OHC into the HIS. 20%Assists in the developing and monitoring of contracts and interagency agreements, including any amendments during the contract/agreement period. Make recommendations to management to ensure compliance with contractual requirements. Assist with Requests for Proposal (RFP) with assistance from Departmental contract and procurement personnel as needed. Coordinate the research and prepare an analysis indicating the pros/cons, alternatives and recommendations to management. 5%Prepare bill analysis, regulations, issue papers, memorandums and reports. Draft formal response to sensitive correspondence for the management’s signature. Prepare budget change proposals, budget assumptions, and statistics reports. Review changes in Medi-Cal and Medicare laws, regulations, and policies and advise management of any impact to recovery process. Write unit procedures and other technical or analytical assignments as assigned. Percent of TimeMarginal Function 5%Other duties as required within the specifications of the class.Employee’s signatureDateSupervisor’ signatureDate ................
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