PRIN HUMAN SVS PLCY & SYS SPEC

State of careers Rhode Island

About The Position

GENERAL STATEMENT OF DUTIES: To perform the most complex technical, analytical, evaluative and liaison work in human service planning and development of policies and systems; and to do related work as required. This position is part of the Customer Resolution Team (CRT) of EOHHS, Medicaid. The candidate hired for this position will be responsible for reconciling discrepancies between the RIBridges Eligibility System and the MMIS payment systems so that the systems accurately reflect an individual's Medicaid eligibility, services and enrollment in MCOs. This is a critical function in accurately supporting individuals/families access to Medicaid Benefits and ensuring that the State is using its Medicaid dollars appropriately. The candidate hired for this position will assist with resolving duplicate eligibility for capitation payments to the Health Plans, resolving 'overlays' and other complex issues between RIBridges and the MMIS. The Breast and Cervical Cancer Program is also maintained in the Reconciliation Unit. The candidate will be crossed trained to support the SSI/MPP and Enrollment Units. They will assist with SSI accretion issues and the Medicare Premium Payment Program. The candidate will also be cross trained in the resolution of medical claims and improved payment processing. This is a fast paced, high- volume position which requires a thorough working knowledge of RIBridges, MMIS, JIRA, and all Microsoft Office programs.

Requirements

A thorough knowledge of the principles and practices of developing human service programs and systems
A thorough knowledge of the methods and techniques involved in the electronic and manual collection and organization of data used in human service programs
The ability to understand electronic file maintenance in policy and eligibility systems
The ability to interpret federal and state laws and regulations and their impact on Department of Human Services policies
The ability to establish and maintain effective working relationships with federal, state and community officials as well as the general public
Excellent oral and written communications skills (providers, consumers, managed care plans, etc)
Proficient in Microsoft Office products, RI Bridges, MMIS
Quick learner
Attention to detail
Investigative skills
Meticulous record keeping
Productive and focused
Resourceful, proactive, organized, critical thinking skills
Comfortable in a fast-paced dynamic agency
graduation from a college of recognized standing; and Experience: Such as may have been gained through: progressively responsible employment in using and/or formulating Department of Human Services policies and/or systems. Or, any combination of education and experience that shall be substantially equivalent to the above education and experience.

Responsibilities

To perform the most complex technical, analytical, evaluative work in the planning and development of human service policies and systems on a statewide basis.
To plan, organize and supervise subordinate specialists in the development of human service policy and systems.
To be responsible for planning and organizing field staff input for the development of electronic policy and systems.
To research, write and edit Department of Human Services policy based upon accurate interpretation of federal/state laws and regulations.
To do related work as required.

Benefits

For information regarding the benefits available to State of Rhode Island employees, please visit the Office of Employee Benefits' website at http://www.employeebenefits.ri.gov/.
Also, be advised that a new provision in RI General Law 35-6-1 was enacted requiring direct deposit for all employees. Specific to new hires, the law requires that all employees hired after September 30, 2014 participate in direct deposit. Accordingly, any employee hired after this date will be required to participate in the direct deposit system. At the time the employee is hired, the employee shall identify a financial institution that will serve as a personal depository agency for the employee.

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