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Commonwealth of Pennsylvania |
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POSITION DESCRIPTION FOR JOB POSTING |
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Position Number: 00192830 |
Description Activated On: 9/22/2025 9:47:23 AM |
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 is a staff position in the Outpatient Rate Setting Section, under the Division of Hospital and Outpatient Rate Setting, Bureau of Fiscal Management (BFM). The incumbent's primary activities are to review, interpret and, if necessary, propose adjustments to financial cost reports submitted by the providers participating in the Medical Assistance Program. Providers include acute care and specialty units of general hospitals, freestanding psychiatric, drug and alcohol, and medical rehabilitation hospitals, Federally Qualified Health Centers (FQHC), and Rural Health Clinics (RHC). Hospital and FQHC financial cost reports serve as the basis for calculating proposed per diem rates for new hospitals and Prospective Payment System (PPS) rates for new FQHCs/RHCs requesting payment rate determination. Additionally, the incumbent is responsible for the review and determination of program exception rate setting for proposed specific procedures and equipment. The incumbent is expected to exercise a high degree of initiative and judgment in completing tasks, many of which are self-initiated, as a result of the review and analysis activities. The incumbent requires knowledge of basic financial analysis principles, Medicare cost reimbursement principles, Medical Assistance regulations, and State and Federal Laws and regulations, as well as their application to the cost reporting system. The incumbent receives direction from the Section Chief. |
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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. 1. Review, interpret and analyze complex financial cost reports submitted by enrolled hospitals and FQHCs to ensure the reports are complete and conform to existing regulations, policies and cost reimbursement principles. This includes a general review and further review of any items or data found to be inconsistent with such regulations or policies. 2. Contact providers’ financial personnel to discuss cost reporting requirements. This involves requesting unreported information, verifying reported information and assisting with corrections before the cost report is considered acceptable. 3. Plan, prepare and update reports which analyze medical assistance providers' financial data and evaluate activity of the providers and the effect on the Medical Assistance Program. 4. Develop proposed payment rates for providers enrolling new hospitals or units and FQHCs in the Pennsylvania Medical Assistance Program. 5. Calculate and prepare cost settlement amounts and reports applicable to excluded units (psychiatric, medical rehabilitation, and drug and alcohol treatment) of acute care hospitals, applicable freestanding specialty hospitals, as well as quarterly wraparound reports for applicable FQHCs and RHCs. 6. Participates in the planning, development, and testing of necessary revisions to the Pennsylvania Automated Cost Reporting System (iPACRS) for enrolled Medical Assistance Hospitals and database maintenance of the FQHC/RHC Rate Manager under the Medicaid Enterprise Monitoring Module (MEMM) for enrolled Medical Assistance FQHCs and RHCs. 7. Review documentation provided by intergovernmental agencies, providers, and vendors to determine rates for program exception procedures and durable medical equipment not included in common pricing modules. 8. Plan, organize, and control the preparation of special reports, briefing papers and other documents on the Medical Assistance provider activity. 9. Read, analyze, and interpret data, reports, regulations, policies, and other written or oral information. 10. Exchange information with others clearly and concisely, to provide information to others on a timely basis within and outside the organization, and to listen, organize, and present thoughts logically in a clear and concise manner, both orally and in writing. 11. Prepare correspondence for the signature of the Section Chief, Division Director, Assistant Bureau Director, Bureau Director, Deputy Secretary and Secretary of Human Services. 12. Perform other related duties as assigned. |
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. Receives assignments from the Section Chief, who gives general guidelines and expected mileposts and completion dates. Works independently and develops detailed plans for project completion. Completed work is given to the Section Chief to be reviewed for thoroughness and accuracy. |
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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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