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State of MichiganCivil Service CommissionPosition Code1. DEPTALTAW80NCapitol Commons Center, P.O. Box 30002Lansing, MI 48909POSITION DESCRIPTIONThis 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 Name (Last, First, M.I.)8. Department/AgencyMDHHS-COM HEALTH CENTRAL OFF3. Employee Identification Number9. Bureau (Institution, Board, or Commission)Medicaid operations and Actuarial Services4. Civil Service Position Code Description10. DivisionDepartmental Analyst-AMedicaid Payments Division5. Working Title (What the agency calls the position)11. SectionClaims AnalystMedicaid Claims Processing Section6. Name and Position Code Description of Direct Supervisor12. UnitVicki Caputo, Departmental Manager 2Institutional Claims7. Name and Position Code Description of Second Level Supervisor13. Work Location (City and Address)/Hours of WorkJessica Bowen, State Administrative Manager 15320 S WALNUT ST; LANSING, MI 48933 / Monday - Friday 8-514. General Summary of Function/Purpose of PositionAs senior level analyst, this position is responsible for monitoring, and maintenance of the Medicaid Management Information System (MMIS) focusing on claims processing related issues. This position serves as a subject matter expert and primary contact for billing questions specific to appropriate medical coding and billing of claims. The position is responsible for researching federal regulations, state legislation and Medicaid policies to determine impact on the operation of the MMIS. The position is responsible for monitoring both manual and automated processing of claims to ensure accurate and timely adjudication. The position is responsible for making recommendations to resolve or minimize errors and for developing plans and testing changes to the MMIS necessary to implement new policies or corrective action. The position is assigned responsibility for leading projects by coordinating resources and providing status reports to management and overseeing projects to completion.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.Duty 1General Summary:Percentage:45Identify changes and enhancements necessary to claims processing editing logic to ensure accurate and timely claims payment consistent with federal and state regulations and Medicaid Policy.Individual tasks related to the duty:Research federal and state regulations and Medicaid policy to determine impact on Claims Processing operations. Research and analyze claims editing and/or payment errors. Identify strategies for corrective action and new policy implementation. Write systems change requests. Test systems changes and approve for implementation. Serve as the chairperson for workgroups and meetings with agency staff.Duty 2General Summary:Percentage:35Serve as a claims coding subject matter expert with respect code and reference data sets, such as NCCI and ICD-10.Individual tasks related to the duty:Utilize the Edifecs tools to translate ICD-9 code sets to the new ICD-10 code sets. Represent the agency as subject matter expert in meetings regarding the transition of codes from ICD-9 to ICD-10. Research questions from internal staff as well as agency staff and provide responses. Participate in activities with respect to NCCI code sets, such as conference calls and workgroups.Duty 3General Summary:Percentage:15Produce account code failure report and recommendations for management approval.Individual tasks related to the duty:Coordinate and attend meetings with accounting and agency staff to review account code failure report and go over findings. Produce reports used to make decisions regarding procedural changes. Research and analyze MMIS/CHAMPS edits and logics to determine impact on account code failure claims. Collaborate with accounting staff to make necessary changes to accounting rules to ensure proper payment of claims. Research questions from staff and provide responses. Duty 4General Summary:Percentage:5Other duties as assigned.Individual tasks related to the duty:Prepare reports and perform analyses for management. Participate in workgroups to provide guidance on various topics related to Medicaid policy and claims processing.16. Describe the types of decisions made independently in this position and tell who or what is affected by those decisions. Approve changes to systems logic that affect payments made to medical providers. Respond to audit inquiries that could impact approval of federal matching dollars.17. Describe the types of decisions that require the supervisor's review. Administrative exceptions to policy. Changes to reimbursement that could significantly impact Medicaid expenditures.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-extended time seated at desk working on computer.19. List the names and position code descriptions of each classified employee whom this position immediately supervises or oversees on a full-time, on-going basis.Additional Subordinates20. This position's responsibilities for the above-listed employees includes the following (check as many as apply):NComplete and sign service ratings.NAssign work.NProvide formal written counseling.NApprove work.NNApprove leave requests.Review work.NApprove time and attendance.NProvide guidance on work methods.NOrally reprimand.NTrain 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?Yes.23. What are the essential functions of this position?The position serves as a subject matter expert and primary contact for billing questions specific to appropriate medical coding and billing of claims. The individual in the position must have extensive, expert knowledge in reference code set as they pertain to Medicaid claims, particularly diagnosis and procedure codes used in billing.24. Indicate specifically how the position's duties and responsibilities have changed since the position was last reviewed.The duties and responsibilities have increased in scope, and reflect that of a senior level analyst.25. What is the function of the work area and how does this position fit into that function?The work area is responsible for the accurate and timely payment of providers enrolled and participating in Medicaid programs. This position ensures that claims are paid timely and accurately, with particular emphasis on how the reference codes used on the claims are supported by the payment system, CHAMPS. The position also supports several audit functions of the CHAMPS system, including the data held within, to verify accurate payments are made.26. What are the minimum education and experience qualifications needed to perform the essential functions of this position.EDUCATION:Possession of a Bachelor's degree.EXPERIENCE:Minimum of one year prior experience at the Departmental Analyst P11 level.KNOWLEDGE, SKILLS, AND ABILITIES:Proficient knowledge of Medicaid programs and policies, skills in tools and applications used as a certified professional coder.CERTIFICATES, LICENSES, REGISTRATIONS:Certified Professional Coder (CPC) NOTE: 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.10/3/2012SupervisorDateTO BE FILLED OUT BY APPOINTING AUTHORITYIndicate any exceptions or additions to the statements of employee or supervisors.N/AI certify that the entries on these pages are accurate and complete.LORI LITTLE10/17/2012Appointing AuthorityDateI certify that the information presented in this position description provides a complete and accurate depiction of the duties and responsibilities assigned to this position.9/21/2012EmployeeDate ................
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