02/12/1998 49250

HIPP OPERATIONS PROGRAM MANAGER

DEFINITION: This is responsible professional and administrative work directing the statewide Health Insurance Premium Payment (HIPP) Program for the Department of Public Welfare.

The employee in this class plans, organizes, and directs the development, operation, and evaluation of a statewide program designed to determine the cost effectiveness of Employer Group Health Programs (EGHP) and Medicare Supplement B/(Medigap) Insurance applications for the purpose of enrolling eligible Medical Assistance recipients into employer group health insurance plans, and for the purchase, administration, and maintenance of the Department's Medigap Program for cost effective, dually eligible Medicare/Medicaid recipients. Work involves determining program needs, proposing modifications in program operations, and the development and implementation of program improvements; directing the development of operating policies and program procedures; reviewing and analyzing federal and state legislation and regulations to determine the impact on the HIPP Program and to ensure that operations are in compliance with federal and state mandates; preparing draft legislation to strengthen current law impacting health insurance premium payment activities; and coordinating and monitoring statewide program operations for adherence to program goals and objectives. Supervision is exercised over a large staff of professional, technical, and clerical positions. Work is performed with a high degree of initiative and independent judgment, and is reviewed by an administrative supervisor through conferences and evaluation of reports for attainment of objectives.

EXAMPLES OF WORK: Plans, organizes, and directs the statewide operation, development, and evaluation of the HIPP Program to achieve overall agency program goals by evaluating applications and enrolling eligible Medical Assistance clients in Employee Group Health and Medigap Programs.

Directs the instruction of HIPP Operations Specialists in the interpretation and application of federal and state mandates, policies, and procedures governing the HIPP Program and state insurance laws. Informs staff of relevant changes and provides clarification, as necessary.

Reviews, analyzes, and evaluates program objectives, policies, and operations; establishes or modifies policies and procedures consistent with Departmental objectives and efficient management practices.

Provides guidance and technical assistance to subordinate staff by resolving complex and sensitive issues.

Directs the review, analysis, and evaluation of federal and state legislation and regulations as they relate to the HIPP Program to assure program compliance and continuing development.

Develops and maintains effective communication and working relationships with other Departmental offices, state agencies, commercial health care and insurance companies, Department of Public Welfare contracted managed health care plans, attorneys, county assistance offices, domestic relations offices, and the Social Security Administration to ensure that HIPP operations run smoothly and meet federal and state requirements/mandates.

Directs, prepares, issues, and evaluates Requests for Proposal; awards and monitors contracts.

Identifies organizational needs, including staffing, organization structure, training, and related budgetary requirements.

Supervises the activities of a professional, technical, and clerical staff.

Employees in this class may participate in the performance of their subordinates work consistent with operational or organizational requirements.

Performs related work as required.

REQUIRED KNOWLEDGES, SKILLS, AND ABILITIES: Knowledge of the principles, practices, and methods of program planning, development, evaluation, and administration.

Knowledge of the provisions, objectives, and goals of legislation and policies applicable to the HIPP Program, state insurance laws, and the requirements of the Health Care Financing Administration (HCFA).

Knowledge of the provisions, health care eligibility criteria, and the billing and provider agreements relating to medical assistance program services, Medicare, Blue Shield and Blue Cross groups, DPW contracted managed care health plans, and commercial health care and liability insurers.

Knowledge of medical terminology, sufficient to read and comprehend medical reports.

Knowledge of resources for researching and obtaining information for case documentation, such as the MAMIS and TPL automated system files, health care providers, and insurance companies.

Knowledge of the principles and practices of public administration, training, and supervision.

Ability to plan, organize, administer, integrate, and coordinate effective program plans, personnel, and budgetary procedures for improved program service delivery.

Ability to exercise judgment and discretion in developing and interpreting objectives, policies, and procedures governing the Department's HIPP Program.

Ability to plan, organize, and prioritize work, and to direct the work force to established goals and objectives.

Ability to express ideas clearly and effectively, both orally and in writing.

MINIMUM EXPERIENCE AND TRAINING: One year of experience as a HIPP Operations Specialist Supervisor;

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Seven years of technical experience in the identification and resolution of third party liability health care claims, analysis of employer group health care plan benefits, or determination of eligibility for health care insurance or medical assistance programs, and which includes one year of experience in a supervisory or administrative capacity.

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Any equivalent combination of experience and training.