Medi-Cal Technician Series

California State Personnel Board Specification

Series established December 1, 1981

Scope

This series specification describes four Medi-Cal Technician classes used to review, justify and recommend the approval or denial of specified Treatment Authorization Requests (TARs) for the Medi-Cal Program and to perform other paratechnical duties specifically related to administration of the Medi-Cal Program.

Definition of Series

Work assignments include responsibility for the review of TARs which do not require professional medical training in the following categories: transportation, drugs and medical supplies for pharmacies, durable medical equipment, home health, hearing aid, speech therapy, physical therapy, occupational therapy, prosthetic and orthotic devices and long-term care authorizations. Specific duties will involve validating the sufficiency of information and support documentation; reviewing beneficiary files to assure that there will be no duplication of services; reviewing regulations to assure the service requested is a program benefit; reviewing procedure codes and diagnosis to assure they are not inconsistent; and assessing cost benefit under specific criteria and guidelines. Incumbents will review the request and recommend its approval, denial or modification, and submit it to a physician or other professional staff for signature. At the superjourney level staff will also perform other technical, analytical, or administrative work associated with the operation of the field office.

Entry Levels

Entry into this series is typically at the class of Medi-Cal Technician I.

Factors Affecting Position Allocation

Complexity of work assigned; and supervision received and/or exercised.

Definition of Levels

Medi-Cal Technician I

This is the entry and first working level for the series. Under supervision and in accordance with preestablished specific criteria and guidelines, incumbents review the least difficult TARs for Medi-Cal benefits.

Medi-Cal Technician II

This is the lead and journey level for the class. Under direction, incumbents either (1) lead a small group (3-5) of Medi-Cal Technicians I, and/or (2) under general guidelines, review more complex TARs for Medi-Cal benefits.

Medi-Cal Technician III (Specialist)

This is the superjourney level for the series. Incumbents will perform a variety of technical, analytical and administrative work associated with the management and operation of Medi-Cal Field Offices, including preparing correspondence to or meeting with providers, beneficiaries, and other public agencies regarding office policies, procedures, and scope of Medi-Cal benefits; preparing position statements for submission to fair hearings requested by beneficiaries for denied services; attempting to resolve fair hearing issues prior to hearings; attending fair hearings as Department representative; performing a variety of administrative work in development and processing of personnel documents, preparation of reports, and advising staff on administrative procedures such as processing of provider appeals, purchase of office equipment, and unusual TARs processing procedures. These positions will be located in the medium and larger field offices.

Medi-Cal Technician III (Supervisory)

This is the full supervisory level for the series. Incumbents either (1) supervise a large unit (10 or more) of Medi-Cal Technicians I and II, including revising and recommending new guidelines or criteria for TARs review by subordinates; or (2)�supervise a medium-sized (5-10) unit of Medi-Cal Technicians I and II and personally review the most difficult TARs assigned to employees in the Medi-Cal Technician series which do not require a medical professional level of review. These TARs include those for which there are only general policies and guidelines, such as durable medical equipment, prosthetic and orthotic devices, home health agencies, transportation, and skilled nursing facilities. Positions at this level will be located in the medium and larger field offices.

Minimum Qualifications

Medi-Cal Technician I

Experience: One year of experience performing work involving the processing of claims or other documents in the general area of social or medical services or face-to-face or telephone contact involving the explanation of interpretation of the products, policies or procedures of an organization. (Experience in the California state service applied toward this requirement must be in a class with a level of responsibility equivalent to that of Office Assistant.) and

Education: Completion of six semester units of college course work in English or the social sciences.

Medi-Cal Technician II

Either I

One year of experience in the California Department of Health Services performing the duties of a Medi-Cal Technician I.

Or II

Experience: Two years of experience performing work involving the processing of claims or other documents in the general area of social or medical services or face-to-face or telephone contact involving the explanation or interpretation of the products, policies or procedures of an organization. (Experience in the California state service applied toward this requirement must include at least one year in a class with a level of responsibility equivalent to that of Medi-Cal Technician I.) and

Education: Completion of fifteen semester units of college level courses which include course work in English, speech, or the social sciences.

Medi-Cal Technician III (Specialist)

Medi-Cal Technician III (Supervisory)

Either I

One year of experience in the California Department of Health Services performing the duties of a Medi-Cal Technician II.

Or II

Experience: Three years of experience involving the processing of claims or other documents in the general areas of social or medical services or face-to-face or telephone contact involving the explanation or interpretation of the products, policies and procedures of an organization. (Experience in the California state service applied toward this requirement must include at least one year in a class with a level of responsibility equivalent to that of Medi-Cal Technician II.) and

Education: Completion of fifteen semester units of college level courses in English, speech, or the social sciences.

Knowledge and Abilities

Medi-Cal Technician I

Knowledge of: Medical terminology and basic grammar and spelling.

Ability to: Analyze TARs accurately to determine appropriateness of approval; follow instructions; work effectively with others; clear and concise expression; write correspondence; deal tactfully with the public over the telephone and in person.

Medi-Cal Technician II

Medi-Cal Technician III (Specialist)

Knowledge of: All of the above.

Ability to: All of the above, and accept increasing responsibility in the level of difficulty of tasks performed, and read and interpret program regulations.

Medi-Cal Technician III (Supervisory)

Knowledge of: All of the above, and principles of supervision; the Department's Affirmative Action Program objectives; a manager's role in the Affirmative Action Program and the processes available to meet affirmative action objectives.

Ability to: All of the above, and plan, organize and direct a staff reviewing and approving TARs; effectively contribute to the Department's affirmative action objectives.

Class History