New Job Medical Care Specialist In Rhode Island

• To review the work of clerical assistants engaged in examining and approving for payment, in accordance with prescribed regulations, bills from the providers of: in-patient hospital services, out-patient hospital services, (clinic, accident room, diagnostic and therapeutic x-rays, pharmacy), physicians' services, drugs, dental services, optometric services, other laboratory and x-ray services, surgical appliances, visiting nurses services, podiatry services, ambulance service, skilled nursing home care, and intermediate care.
• To investigate and determine validity of claims from outside the state, and of any others which present difficult determination of eligibility.
• To consult with Social Workers and Physicians with regard to requests for special medical items or services which are not available through regular provider channels and to advise them of other available community resources.
• To review medical and social information relating to applications for admission to nursing or intermediate care facilities.
• To review and apply informational and directive communications bearing on federal and/or state legislation with reference to the medical care program, and other related programs.
• To assist in the preparation of rules, regulations, procedures, and fee and cost standards governing the procurement and payment of medical services and supplies; and to inform local welfare directors, certifying officers and other welfare officials and staff members thereof.
• As required, to compile statistics and prepare special reports on various phases of the program.
• To do related work as required.

KNOWLEDGES, SKILLS AND CAPACITIES: A thorough knowledge of the provisions of the Rhode Island Medical Assistance Program as it relates to in-patient hospital services, nursing and intermediate care services, visiting nurse services, and drugs for consumption by in-patients or other persons; the ability to interpret and apply such knowledge; the ability to supervise and review the work of clerical assistants engaged in examining and approving for payment bills for a variety of medical services; the ability to assist in the preparation of rules, regulations, procedures, and fee and cost standards governing the procurement and payment of medical services; the ability to maintain good relations with associates and the public; and related capacities and abilities.

EDUCATION AND EXPERIENCE:

Education: Such as may have been gained through: graduation from a college of recognized standing; and
Experience: Such as may have been gained through: employment in a responsible position assisting in the supervision of the processing of claims, or requests for benefits or services in such areas as medical care administration, hospital administration, public administration, social welfare, or in a health or accident insurance program.
Or, any combination of education and experience that shall be substantially equivalent to the above education and experience.

Executive Office of Health and Human Services