JOB TITLE: DIRECTOR, BUREAU OF FISCAL MANAGEMENT, OMAP

JOB CODE: 44125

DEFINITION:

This is responsible professional and administrative work directing the rate and fee setting and financial management activities of all physical health Medical Assistance (MA) programs for the Office of Medical Assistance Programs (OMAP) in the Department of Human Services (DHS).

The employee in this job directs and monitors the bureau’s rate setting and financial management activities involving hospitals, HealthChoices (HC) Managed Care Organizations (MCOs), the Fee-for-Service (FFS) fee schedule, Federally Qualified Health Centers, Rural Health Clinics, and Medical Assistance Transportation Program (MATP) contractors. Work involves planning, organizing, and directing rate development and directing policy and procedural development for rate development, budgetary projections, third party collections, stop-loss provisions, reinsurance, and other forms of risk limitation, and financial monitoring plans for managed care organizations and fee-for-service providers. Work also includes directing payments and the development and implementation of new program payment processes; directing the management of risk pools, contract specific funding pools, rates, and supplemental payments to MA providers; tracking change of ownership entities through sale or merger; ensuring that hospital supplemental payments do not exceed established federal and state limits; and directing the financial reporting by managed care organizations and analysis of financial data to understand costs, to determine financial strength, and to determine contract compliance with MA regulations. Supervision is exercised over program, accounting, and fiscal staff. Work is performed independently under the general direction of the OMAP Deputy Secretary.

EXAMPLES OF WORK: (NOTE: The examples of work are representative of the work, but every position classified to this job may not perform all examples of work listed. Conversely, this is not an all-inclusive list of work examples.):

• Directs all financial management activities related to the provision of physical health services by providers in the state’s Medical Assistance Programs.

• Develops, implements, and evaluates policies related to rate and fee settings, assessments, and adjustments related to fiscal charges for services provided by physical health Medical Assistance Program providers.

• Oversees the financial monitoring of HC MCOs.

• Manages HC revenue including rate recommendations and negotiations, and ongoing management of risk sharing, risk pools, and supplemental payments.

• Manages the hospital assessment, the Philadelphia hospital assessment, hospital cost reporting, and Disproportionate Share and other supplemental payments to hospitals.

• Provides informed direction to DHS’ actuary contractor on rate and fee setting methodology, implementation, and evaluation.

• Supports the Secretary’s Office and the Deputy on federal revenue maximization initiatives that include hospitals and managed care organizations.

• Plans, directs, and manages the financial budget operation for the Commonwealth's Medical Assistance Programs within OMAP, which includes all program and administrative OMAP appropriations, grants, and augmenting revenues.

• Oversees the financial management of OMAP administrative contracts.

• Serves as liaison with the Centers for Medicaid and Medicare Services (CMS) on HC financial matters including waiver requests and rate approvals to secure funding.

• Performs the full range of supervisory duties.

• The employee in this job may participate in the performance of subordinates’ work consistent with operational or organizational requirements.

• Performs related work as required.

ENTRY LEVEL KNOWLEDGES, SKILLS, AND ABILITIES:

• Knowledge of accounting systems.

• Knowledge of the goals and objectives of MA managed care programs.

• Knowledge of the principles and methods of actuarial analysis.

• Knowledge of the principles and methods of statistical analysis.

• Knowledge of the principles and methods of rate formulation.

• Knowledge of the principles and practices of effective supervision.

• Ability to read, analyze, and interpret policies, procedures, and regulations.

• Ability to prepare and interpret financial reports and statements.

• Ability to establish and maintain effective working relationships.

• Ability to communicate effectively orally.

• Ability to communicate effectively in writing.

MINIMUM EXPERIENCE AND TRAINING: (NOTE: Based on the Entry Level Knowledges, Skills, and Abilities):

• Six years of professional accounting and financial management experience in a managed health care setting including two years in a supervisory capacity; and a bachelor’s degree;

or

• An equivalent combination of experience and training that includes two years of professional supervisory experience in a managed health care setting.