JOB TITLE: DIRECTOR, BUREAU OF FEE-FOR-SERVICE PROGRAMS, OLTL

JOB CODE: 48864

DEFINITION: This is professional managerial and administrative work directing the oversight of statewide long term care fee-for-service programs in the Department of Human Services’ (DHS) Office of Long Term Living (OLTL).

The employee in this job plans, develops, and directs various support services for long term care fee-for-service providers and ensures provider compliance with federal and state laws and regulations. Work includes developing program policies and guidelines; managing provider enrollment and Medical Assistance (MA) certification of nursing facilities and home and community based service (HCBS) providers; directing the delivery of statewide training and the development of informational materials related to long term care programs; and overseeing fee-for-service claims management and the resolution of billing and payment issues. Extensive contact is maintained with various department program administrators and representatives of federal, state, and long term living provider agencies and organizations to continually improve program service delivery. Supervision is exercised over professional and technical staff. Work is performed with a high degree of initiative under the general direction of the Deputy Secretary for Long Term Living and is reviewed through conferences and reports for achievement of goals, objectives, and overall program quality.

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 the development, revision, and implementation of regulations, policies, and procedures to ensure the appropriate utilization of MA services and reimbursements and overall compliance with federal and state requirements.

• Directs the development of operational policies and informational bulletins, handbooks, and other materials related to long term care provider operations and fee-for-service activities.

• Directs the development and implementation of various training programs on MA policies and procedures for long term care providers.

• Directs the provision of technical assistance to long term care providers to assist with ongoing regulatory compliance and to address compliance issues.

• Directs enrollment, licensing, and revalidation of long term living services and supports providers.

• Directs the review of billing and claims processing issues to ensure accurate provider payments in accordance to state and federal regulations.

• Directs quality management efficiency teams, which audit and analyze services delivered by providers to determine compliance with state and federal regulations.

• Coordinates negative sanctions against long term living providers as required by state and federal regulations, including the coordination of civil monetary penalties.

• Reviews and comments on proposed legislation affecting long term living provider services and programs.

• Confers with state legislators, federal and state agencies, various organizations and interest groups, and individuals on long term living provider regulatory compliance issues.

• Ensures provider databases are maintained in accordance with federal requirements.

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

• Performs the full range of supervisory duties.

• Performs related work as required.

ENTRY LEVEL KNOWLEDGES, SKILLS, AND ABILITIES:

• Knowledge of the laws and regulations governing long term living programs and services.

• Knowledge of home and community based long term living programs and services.

• Knowledge of the principles and methods of policy and program planning, development, and evaluation.

• Knowledge of the principles and practices of supervision.

• Ability to analyze and interpret program and fiscal data.

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

• Ability to establish and maintain effective working relationships.

• Ability to communicate effectively in writing.

• Ability to communicate effectively orally.

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

• Six years of professional experience in the development, implementation, and evaluation of a human services program, including three years in a supervisory capacity in a long term living program, and a bachelor’s degree;

or

• An equivalent combination of experience and training that includes three years in a professional supervisory capacity in a long term living program.