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Commonwealth of Pennsylvania |
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POSITION DESCRIPTION FOR JOB POSTING |
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Position Number: 00180832 |
Description Activated On: 4/6/2026 1:19:00 PM |
Position Purpose: Describe the primary purpose of this position and how it contributes to the organization’s objectives. Example: Provides clerical and office support within the Division to ensure its operations are conducted efficiently and effectively. This position is in the Division of Special Payments (DSP) within the Office of Medical Assistance Programs’ Bureau of Fiscal Management (BFM). OMAP oversees the Physical Health component of the HealthChoices Program. HealthChoices (HC) is the name of Pennsylvania's mandatory managed care program for Medical Assistance beneficiaries. Through Physical Health Managed Care Organizations (PH-MCOs), beneficiaries receive quality medical care and timely access to all appropriate physical health services. The Department pays capitation and other payments to the PH-MCOs for MA beneficiaries enrolled in their managed care plan. The PH-MCOs are responsible to pay their providers and must manage costs and risk associated with providing those services. To help mitigate the inherent risk in certain high-cost populations, the HC agreements include risk sharing, non-risk sharing, and risk pool arrangements. The HC agreements also include incentive arrangements that provide PH-MCOs with additional funding for performance in certain targeted areas. In addition, payments are made to the PH-MCOs to fund the Hospital Quality Incentive Program. Finally, overpayment recoveries are processed in accordance with the HC agreements and Bureau of Program Integrity reports. The position is responsible for the validation and processing of the payments and recoveries described above. In addition, this position is responsible for any research, analysis, and fiscal impact related to the House Resolution 1 (H.R. 1) Bill. |
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Description of Duties: Describe in detail the duties and responsibilities assigned to this position. Descriptions should include the major end result of the task. Example: Types correspondence, reports, and other various documents from handwritten drafts for review and signature of the supervisor. This position performs in-depth analytical reviews of large-volume, large-dollar Under Age One Risk Sharing, Home Nursing Risk Sharing, High-Cost Risk Pool, and High-Cost Gene Therapy Non-Risk Sharing data files. This position validates the eligibility for and computation of payments to the PH-MCOs as compiled by the Data Unit in accordance with the applicable HC Agreement. This position works with Hospital Quality Incentive Payments (HQIP), and State Directed Payments, in addition to MCO, Integrated Care Plan Program, and Medication Adherence Pay for Performance payments. In addition to the above special payments, the incumbent also processes credit Gross Adjustments and immediate revenues as well as overpayment recoveries for the Bureau of Program Integrity. This position follows the following general procedures in administering these payments: •This position works closely with internal and external parties including, but not limited to, Data Unit, Comptroller, and/or PH-MCOs to validate data, maintain the programming logic, and ensure contract compliance to determine and support calculations for the various payments/settlements. •This position does analysis and preparation of communications to the PH-MCOs and the Hospitals related to the Hospital Quality Incentive Payments (HQIP) and State Directed Payments. •This position communicates regularly with PH-MCOs concerning special payment data files. •This position creates Gross Adjustments by employing the use of the PROMISe, DocuShare, COLD and Business Warehouse systems, and must verify Federal and State payment share amounts based on current FFP percentages. •This position will research provider tax changes as enacted in H.R. 1. This includes, but is not limited to, monitoring and analyzing the safe harbor provider tax ceiling and ensuring the proper phase down beginning in 2028 and ending in 2032. •This position will analyze state directed payment changes as enacted in H.R.1. This includes, but is not limited to, reviewing preprints for compliance with federal regulations, understanding grandfathered payments and the implications beginning January 1, 2028, and ensuring language in the MCO agreement reflects changes to impacted exhibits. •This position will prepare fiscal impacts related to Medicaid provisions as outlined in H.R. 1. • This position works with the Bureau of Program Integrity and the Data Unit to recoup overpayments to providers. •This position produces various reports on a regular and/or ad hoc basis related to other special payment programs regarding budget presentation, program changes, and rate setting. •This position identifies areas where work can be streamlined and improved along with any potential issues of error and makes recommendations to the supervisor to update program instruction manuals periodically and when changes occur. •This position must be aware of and follow retention guidelines pertaining to the proper electronic storage of information and supporting documentation. •This position performs other related work as required. |
Decision Making: Describe the types of decisions made by the incumbent of this position and the types of decisions referred to others. Identify the problems or issues that can be resolved at the level of this position, versus those that must be referred to the supervisor. Example: In response to a customer inquiry, this work involves researching the status of an activity and preparing a formal response for the supervisor’s signature. This position makes decisions based on direction received by the supervisor in performance of technical work, analysis of data, and resolution to issues at hand. This position will use the applicable HealthChoices agreement as a guide in making decisions. This position makes recommendations to the supervisor based on research, or as the result of assignments completed. |
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Requirements Profile: Identify any specific experience or requirements, such as a licensure, registration, or certification, which may be necessary to perform the functions of the position. Position-specific requirements should be consistent with a Special Requirement or other criteria identified in the classification specification covering this position. Example: Experience using Java; Professional Engineer License Experience: Licenses, registrations, or certifications: 1. N/A 2. N/A 3. N/A 4. 5. 6. |
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Essential Functions: Provide a list of essential functions for this position. Example: Transports boxes weighing up to 60 pounds.
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