08/24/2001 44120

DIRECTOR, BUREAU OF DATA AND CLAIMS MANAGEMENT, OMAP

DEFINITION: This is responsible administrative and professional work managing complex management information systems which support the Office of Medical Assistance Programs (OMAP).

The employee in this class is responsible for planning, organizing and directing the development, implementation and maintenance of the Medical Assistance Management Information System (MAMIS) and supporting systems and activities related to Medicaid invoice processing and payments to providers and contractors. Work involves developing, evaluating, interpreting and implementing policies, regulations and procedures concerning the management of information systems, and the communication and exchange of data for the medical assistance programs' operations; directing the operations of large and complex integrated information systems supporting the Pennsylvania Medical Assistance Program; and planning for technology initiatives and developing technology policy related to new federal requirements for Medicaid programs including new legislation or regulations. The duties include negotiating and managing vendor contracts; developing and maintaining the managed care management information systems; directing, planning, and developing modifications to automated systems and communication of data; ensuring the integrated information systems and the communication of data are in compliance with program goals, objectives, and regulations; directing research activities and approving  and monitoring the conversion of medical assistance policy and regulations to operational systems, including the use of information technology; coordinating fiscal issues with the Comptroller and the Department's financial management staff; and developing the information technology budget needs for OMAP. Supervision is exercised over professional, technical, and clerical employees. Work is performed with a high degree of initiative and independent judgment limited only by federal and state legislation and Departmental policy and is reviewed and supervised by the Deputy Secretary for achievement of goals through ongoing conferences, reports, and evaluation of medical assistance programs overall effectiveness.

EXAMPLES OF WORK: Plans, organizes, directs, and develops policy for the analysis, design, development, implementation, and operation of management information systems, and the communication and exchange of data for OMAP.

Plans, organizes, and directs the development and maintenance of OMAP's management information systems, including the locally developed software; the coordination and approval of MAMIS systems development and implementation; the installation and maintenance of PC hardware and software; and the management of OMAP's local area networks.

Provides leadership and guidance to OMAP bureaus on large and complex integrated information systems utilizing local area, wide area, and metropolitan area networks to assist in meeting overall Medical Assistance Program goals and objectives.

Directs all activities related to Medicaid invoice processing and payments to providers; and coordinates claims processing activities with the Office of Information Systems, contractors, other OMAP managers, the Comptroller and other Departmental managers.

Directs the development and maintenance of an automated medical assistance information reference file system which includes automated procedural, diagnosis, and edit error files.

Provides operational support to the managed care programs including Health Maintenance Organization (HMO) eligibility and enrollment and HMO systems payment support.

Directs the effective development, integration, and ongoing inter-bureau information technology support.

Negotiates contract amendments and defines requirements for new or revised MAMIS-related activities that are assigned to the contractor; negotiates the annual contract renewal with the contractor.

Provides leadership and guidance to division directors on fee-for-service and managed care automated systems to assist in meeting overall program office goals and objectives.

Directs division chiefs engaged in numerous complex programs involving the editing, payment, filing and reporting of medical assistance service providers' invoice claims.

Provides for training required to maintain the organizational expertise required to meet established goals and objectives.

The employee in this class may participate in the performance of his/her subordinates' work consistent with operational or organizational requirements.

Performs related duties as required.

REQUIRED KNOWLEDGES, SKILLS, AND ABILITIES: Knowledge of the principles, practices, methods, and current developments in the field of medical assistance.

Knowledge of management information systems and technological and general administrative principles and practices.

Knowledge of federal and state laws, rules, standards, policies, and Departmental procedures governing the administration of the Commonwealth's Medical Assistance Program.

Knowledge of the principles and practices of administration and supervision.

Ability to plan and administer the activities of a large group of professional planning, system development, technical support and operations staff.

Ability to direct the development of complex automated information systems and the associated policies and procedures based upon medical assistance program requirements and federal and state mandates.

Ability to direct the conversion of technical program reporting requirements to information systems processing and/or other management methods involving managed care initiatives.

Ability to provide leadership and guidance and to establish effective working relationships with Departmental personnel; public and private agency management officials; vendors; and representatives of federal, state, and local governments.

Ability to analyze and evaluate the effectiveness of management information services and resources.

Ability to communicate effectively, orally and in writing.

MINIMUM EXPERIENCE AND TRAINING: Seven years of experience in systems analysis or design work involving electronic data processing methods or management information systems that includes two years working with medical assistance programs or health care insurance, and which also includes three years in an administrative, consultative or supervisory capacity involving planning and coordinating the development and implementation of human service programs, and a bachelor's degree;

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An equivalent combination of experience and training.