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State of Washington Classified Job Specification

MEDICAL PROGRAM SPECIALIST 3

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MEDICAL PROGRAM SPECIALIST 3
162G
Category: Financial Services

Class Series Concept

See Medical Program Specialist 1, 162E

Definition

Positions at this level serve as an expert or supervisor of staff engaged in the review, analysis, and monitoring of health care best practices and cost containment programs, or medical compliance auditing.  Provides consultative expertise regarding healthcare program quality and effectiveness to top-level managers. 

Distinguishing Characteristics

Directs and supervises a unit comprised of professional and/or paraprofessional staff engaged in the review, analysis, monitoring, and/or operation of health care program’s quality and effectiveness; or, manages and directs the development of statewide health care initiatives and long-term purchasing improvement projects to ensure patient access to quality care. 

Typical Work

Provides administrative direction to subordinate staff regarding system operations or projects and initiatives;  

Plans, directs, coordinates and evaluates the activities of subordinate managers and/or other professional staff;  

Establishes and directs administrative policy for a section; establishes goals and objectives for programs and staff;  

Directs the design and development of comprehensive statewide program reviews, plans, policies and procedures for medical provider service delivery;  

Organizes and administers audit review process;  

Provides consultative services to department staff and medical providers regarding the interpretation of medical policies and procedural coding;  

Oversee the work of staff who perform coding compliance audit reviews; 

Supervises coordination of findings from audit reviews with professional staff to develop and implement specific policies for the health care programs;  

Prepares comprehensive, long-range plans relating to health care program objectives;  

Supervises the resolution of, and resolves, program issues arising from the audits of medical providers;  

Evaluates the effectiveness of health care program policies and initiatives and their impact on injured workers, medical providers and expenditures; 

Performs other duties as required.

Knowledge and Abilities

Knowledge of:  state policies and regulations related to health care programs; principles and practices of program planning and evaluation; current trends and economic problems relating to health care cost and the injured worker; health care organizations and industry; principles of supervision and staff development; the legislative process. 

Ability to:  develop, implement and evaluate programs; work effectively with program staff, providers, and other affected parties; analyze and resolve complex problems related to health care cost programs; communicate clearly and effectively both orally and in written form; select, train, supervise, and evaluate staff. 

Legal Requirement(s)

There may be instances where individual positions must have additional licenses or certification. It is the employer’s responsibility to ensure the appropriate licenses/certifications are obtained for each position.

Desirable Qualifications

One year of experience as a Medical Program Specialist 2.  

OR 

Two years of experience as a Medical Program Specialist 1. 

OR 

A Master's degree with major study in public health, public administration, nursing, health administration, economics, business administration, or closely allied field AND three years of supervisory or consultative experience in a health services program.  

Two additional years of qualifying experience may be substituted for the Master's degree provided a Bachelor's degree in one of the above fields has been achieved. 

OR 

Equivalent education/experience. 

Note: For positions supervising staff performing medical coding work, a Certified Professional Coder (CPC) certification, or equivalent, may be required.

Class Specification History

New class adopted May 10, 2007, effective July 1, 2007.
Revise class. Added class series concept, distinguishing characteristic; revised definition, typical work, desirable qualifications, adopted June 13, 2019, effective July 1, 2019.

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