Medical Assistance Program Technician

Commonwealth of Pennsylvania; Harrisburg (Dauphin County); Hybrid; USD 42,000 - 56,000; Full time

Benefits offered by this job

Free parking

Telework option

Job summary

Commonwealth of Pennsylvania is seeking a Medical Assistance Program Technician to support the Bureau of Program Integrity in the Division of Third Party Liability, Recovery. You will review complex medical and financial claims, gather necessary information, and ensure accurate processing of statements of claims in compliance with federal and state rules.

The role emphasizes precise calculation, data interpretation, and adherence to policy.

Qualifications

• Three years of para-technical experience in reviewing and responding to inquiries relating to health care insurance programs, health care services, or medical assistance program services.
• Any equivalent combination of experience and training.

Responsibilities

• Review, analyze, and compute medical, cash, personal injury, and estate claims for recovery.
• Decode, analyze, calculate, and summarize information in medical claims.
• Contact facilities and agencies to obtain required details.
• Calculate and update payment amounts using federal standards.
• Review and interpret client encounter data from managed care organizations to explain fiscal processes.
• Identify adjustments to claims to create and update statements of claims.
• Apply federal and state regulations and policies to follow proper procedures.

Skills

Para-technical experience

Analytical thinking

Education

Three years para-technical experience in health care programs

Job description

Are you interested in technical and administrative work that helps state medical assistance program services run fairly and effectively? Apply for this Medical Assistance Program Technician role with the Bureau of Program Integrity, Division of Third Party Liability, Recovery Section, Statement of Claim Creation Unit. With us, you will review, analyze, and compute medical, cash, personal injury, and estate claims in which the Commonwealth seeks recovery, ensuring work is accurate, consistent, and uses the correct standards. Take the next step in your career as part of a team that works to protect public resources, strengthen financial accountability, and support community wellbeing!

This position focuses on decoding, analyzing, calculating, and summarizing information in medical claims. Work supports accurate and timely creation and processing for statement of claims across various medical and financial situations. As a Medical Assistance Program Technician, you will perform the following duties:

• Claim Analysis: Independently review complex medical claims to determine which relate to specific personal injury or decedent estate cases
• Information Gathering: Contact facilities and agencies as well as analyze correspondence and forms to obtain required details
• Computations: Calculate and update medical and cash payment amounts by determining the amount of cash received using the correct standards permitted by federal law
• Data Explanations: Review and interpret complex client encounter data from managed care organizations to explain the fiscal processes determining the amount due and owed
• Adjustment Updates: Identify adjustments made to claims to create and update statement of claims
• Regulation Knowledge: Apply federal and state regulations and policies to independently identify and follow proper procedures.

Interested in learning more? Additional details regarding this position can be found in the position description.

Work Schedule and Additional Information:

• Full-time employment
• Work hours are 8:00 AM to 4:00 PM, Monday - Friday, with a 30-minute lunch.
• Free parking.
• Telework: You may have the opportunity to work from home (telework) part-time, up to three days per week. In order to telework, you must have a securely configured high-speed internet connection and work from an approved location inside Pennsylvania. If you are unable to telework, you will have the option to report to the headquarters office in Harrisburg. The ability to telework is subject to change at any time. Additional details may be provided during the interview.
• Salary: In some cases, the starting salary may be non-negotiable.
• You will receive further communication regarding this position via email. Check your email, including spam/junk folders, for these notices.

QUALIFICATIONS

Minimum Experience and Training Requirements:

• Three years of para-technical experience which involved reviewing and responding to inquiries relating to applicable services or benefits in health care insurance programs, health care services, or medical assistance program services; or
• Any equivalent combination of experience and training.

Other Requirements:

• You must meet the PA residency requirement. For more information on ways to meet PA residency requirements, follow the link and click on Residency Guidelines.
• You must be able to perform essential job functions.

This position is subject to the provisions of a collective bargaining agreement or memorandum of understanding.

You must be eligible for selection in accordance with merit system employment regulations.

Recruitment Methods:

• Applicants must meet one of the following methods to be considered for this vacancy:
  • Promotion Without Exam
  • Reassignment (Only current civil service employees in the same agency who hold the same or similar job title, with the same maximum salary, within the same occupational group or where there is a logical career movement, will qualify for reassignment.)
  • Transfer (Only current civil service employees who hold the same job title will qualify for transfer to another agency.)
  • Voluntary Demotion
  • Reinstatement (Former civil service employees may only be reinstated to the job title from which they resigned. Current civil service employees are not eligible through reinstatement.)

Promotion Without Examination (PWOE):

• Class Restrictions for Promotion Without Examination Only - You must have or have held regular civil service status in one of the following classifications:
  • Fiscal Assistant
  • Clerical Assistant 3
  • Clerical Supervisor 1
  • Medical Records Assistant
• Employees who previously held regular civil service status in the job title of the position being filled are also eligible for promotion without examination.
• The promotion without examination requirements are issued in accordance with merit system employment regulations.
• Meritorious service is defined as (a) the absence of any discipline above the level of written reprimand during the 12 months preceding the closing date of the posting, and (b) the last regular or probationary performance evaluation showing an overall rating of satisfactory or higher.
• Applicants must have a minimum of one year in the next lower classes by the posting closing date with no break in service.

Telecommunications Relay Service (TRS):

• 711 (hearing and speech disabilities or other individuals).

If you are contacted for an interview and need accommodations due to a disability, please discuss your request for accommodations with the interviewer in advance of your interview date.

The Commonwealth is an equal employment opportunity employer and is committed to a diverse workforce. The Commonwealth values inclusion as we seek to recruit, develop, and retain the most qualified people to serve the citizens of Pennsylvania. The Commonwealth does not discriminate on the basis of race, color, religious creed, ancestry, union membership, age, gender, sexual orientation, gender identity or expression, national origin, AIDS or HIV status, disability, or any other categories protected by applicable federal or state law. All diverse candidates are encouraged to apply.