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OFFICE
OF HUMAN RESOURCES > CLASSIFICATION
> SPECIALIST, INSURANCE & RETIREMENT, MEDICARE/MEDICAID
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Specialist, Insurance & Retirement, Medicare / Medicaid |
5640 |
| Employee
Retiree Service Center Medicare/Medicaid Specialist |
19 |
| Under general supervision,
is responsible for managing all aspects of MCPS’ participation
through the Retiree Benefit Plan of the Medicare Part
A, B and D programs and the Medicaid program, and
to make recommendations for policy changes that ensure
effective program operations. Responsible for all
aspects of program communication, requirements, data
preparation, data entry, batch system processing,
program analysis, reporting, customer service and
problem resolution. Responsible for the overall data
integrity of the Medicare and Medicaid information
within the MCPS Human Resource Information System.
Serves as the MCPS expert and program leader regarding
these programs and functions as the liaison with OIOS
in these programs. |
| This position requires knowledge
of all of the seven core competencies of the Supporting
Services Professional Growth System (SSPGS) to include
commitment to students, knowledge of job, professionalism,
interpersonal, communication, organization, and problem
solving. Knowledgeable in all aspects of the Medicare
and Medicaid programs and the operation of employer
sponsored health plans. Knowledge of MCPS benefits
programs, policies, and negotiated agreements. Requires
skill in completing program and systems documentation;
strong communication, oral presentation, counseling,
interpersonal and organizational skills; working knowledge
of standard database technologies and their use in
reporting and transferring information; strong consultation
skills necessary to work effectively with others designing,
evaluating and executing complex program requirements.
Must be detail-oriented and accurate in the preparation
of reports and data management. Ability to prepare
and present management reports and program analysis
utilizing Oracle Discoverer and the Microsoft Office
suite. Must be independent, highly organized, self-motivated
and able to work effectively in a fast-paced environment.
Ability to plan and manage multiple tasks in a timely
manner. |
Associate or Bachelors degree
from an accredited college or university. preferred.
Considerable experience working with Microsoft Excel,
Access, and Power Point. Working knowledge of Oracle
Discoverer, Crystal Reports, or other reporting tools;
working knowledge of the MCPS Human Resource Information
System (Lawson) or other integrated human resource
information system preferred; experienced with the
operation of employer sponsored health plans required.
Other combinations of education, training and experience
that provide the knowledge, abilities and skills necessary
to perform effectively in this position may be considered.
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| None |
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(Special requirements such as lifting heavy objects and
frequent climbing.) Position requires sustained operation
of keyboard devices. |
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(Frequent overtime or night work required, etc.) Ability
to work nights and weekends as required to meet program
obligations. |
| No |
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A. Medicare Part D – Prescription Drug Program
1. Develop and maintain written procedures and all documentation
for the Part D Prescription Drug Program
2. Serve as primary contact and liaison with responsibility
for the overall execution of the program
3. Advise and educate MCPS Staff on program changes using
written materials and presentations
4. Prepare, validate, and upload enrollment files
5. Download RDS response files and weekly notification
files and make necessary corrections
6. Analyze and follow up on response files including
benefit enrollment changes in Lawson
7. Responsible for preparing and disseminating written
and verbal communication to retirees and dependents concerning
Medicare Part D issues, determinations of eligibility,
options and actions
8. Responsible for the annual Statement Of Creditable
Coverage Disclosure process
9. Review, analysis and problem resolution regarding
revenue reporting from the Pharmacy Benefit manager
10. Conduct presentations to retirees regarding the Medicare
Part D program requirements and integration with MCPS
provided benefits. Lead meetings and forums during retiree
open season
11. Proactively look for new opportunities to improve
communications and processes to reduce the number of
ERSC contacts for assistance.
12. Resolution of retiree issues and appeals
13. Maintenance of retiree Medicare data in Lawson
14. Responsible for tracking and validation of claims
and subsidy data received from the Pharmacy Benefit Manager.
15. Periodic analysis and formal annual reporting of
program enrollment, expenditures, revenue, issues and
issues management, and other statistics as needed using
appropriate software packages.
B. Medicare Part B – Retiree Benefit Enrollment
Records and Communication
1. Develop and maintain written procedures and documentation
for the Medicare Part B program, including enrollment
processing in Lawson
2. Serve as the MCPS in-house expert for Medicare and
Medicaid programs
3. Advise and educate MCPS Staff on program changes using
written materials and presentations
4. Develop and run reports to identify employees as they
age into Medicare Part B eligibility.
5. Prepare and disseminate written and verbal communications
including the letter notification process in order to
successfully transition retirees and dependents into
Medicare required coverage -- additional communication
might include articles for Retiring Times, For Your Benefit,
and Understanding Your Retirement publications
6. Research and resolve retiree Medicare coverage issues
and problems.
7. Conduct annual open season meetings and presentations
to educate retirees about Medicare issues and requirements.
Develop handout materials as needed.
8. Proactively seek look for new opportunities to improve
communications and processes to reduce the number of
ERSC contacts for assistance
C. Annual Medicare Match Program – Center for Medicare
and Medicaid Services (CMS)
1. Develop and maintain written procedures and documentation
for the Annual Medicare Match Program
2. Advise and educate MCPS Staff on program changes and
requirements using written materials and presentations.
3. Serve as primary contact and liaison with CMS
4. Responsibility for the overall execution of the program
5. Validate and ensure reporting accuracy
6. Resolution and research of inquiries from CMS and
related issues
7. Coordinate claims and Medicare repayment issues with
medical carriers.
Performs related work as required |
7/2007
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This description may be changed at any time.
Note: A general guide to class description, which includes
definitions of standard terms used, is considered an integral
part of this description and is available
from the Office of Human Resources. |
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