12/18/2008 44155

MEDICAL ASSISTANCE FEE-FOR-SERVICE FINANCIAL MANAGER

DEFINITION:

This is professional administrative and advanced technical work directing rate setting, policy development, and financial management for the physical health fee-for-service programs in the Department of Public Welfare.

The employee in this job directs and monitors rate setting, fiscal policy development and implementation, institutional provider cost reporting and financial management for the physical health fee-for-service programs. Work involves planning, organizing, and directing rate development for fee-for-service providers; directing contract management of actuarial support; 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. Work also includes directing payments and the development and implementation of new program payment processes; directing the management of risk pools, escrows, rates and supplemental payments to 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 analysis of financial data to determine solvency and contractual compliance. Supervision is exercised over professional program, accounting or financial specialist staff performing complex and highly technical research, program analysis or program development work. Work is performed with considerable independence under the general direction of an administrative manager.

EXAMPLES OF WORK:

Directs professional staff in the financial management of the Medicaid physical health fee-for-service programs.

Directs the development of fee-for-service rates, policy and procedures.

Directs the management and monitoring of actuarial support services provided by contractors.

Directs the analysis, development, and negotiation of payment rates for fee-for-service providers.

Provides financial information and recommendations for the negotiation of fee-for-service hospital rate agreements and directs their implementation.

Directs the contracting process for health care consulting services.

Negotiates rates and supplemental payments with fee-for-service providers for DPW review and approval.

Oversees system updates for fee-for-service provider name and ownership changes.

Projects carry-forward budget requirements of the Medicaid-funded physical health fee-for-service programs.

Resolves Medicaid physical health fee-for-service issues with consulting groups, contractors and providers. Represents OMAP on various fee-for-service fiscal committees.

Directs the development and analysis of financial reports used for DPW financial policy determination.

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.

REQUIRED KNOWLEDGES, SKILLS, AND ABILITIES:

Knowledge of governmental accounting and financial management principles and methods and their application to fee-for-service accounting systems.

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 communicate effectively orally.

Ability to communicate effectively in writing.

Ability to establish and maintain effective working relationships.

MINIMUM EXPERIENCE AND TRAINING:

Five years of professional accounting and financial management experience within the managed care field, physical health fee-for-service program field, or behavioral health fee-for-service program field, including one year of supervisory experience.