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Commonwealth of Pennsylvania |
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POSITION DESCRIPTION FOR JOB POSTING |
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Position Number: 00204536 |
Description Activated On: 1/5/2026 9:26:01 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. The purpose of this position is to support the Office of Developmental Programs’ Provider Qualifications and Enrollment functions by leading, overseeing, and ensuring consistent statewide implementation, compliance, and operational integrity of provider enrollment, qualification, and ongoing compliance requirements across ODP-administered waivers. This position provides central office programmatic, fiscal, and systems oversight related to provider qualifications and enrollment, including interpretation and application of federal and state requirements; development of policy, operational guidance, and technical assistance; coordination of monitoring and enforcement activities; and collaboration with internal and external stakeholders to promote compliance, quality, and participant health and safety. In addition, the position serves as the ODP Central Office subject matter expert for Participant-Directed Services (PDS) and Electronic Visit Verification (EVV), providing statewide leadership and oversight of PDS delivery models and EVV requirements within the Consolidated, Community Living, and Person/Family Directed Support (P/FDS) waivers. In this role, the position supports consistent statewide operations through data analysis, provider and system monitoring, technical assistance, and collaboration with Administrative Entities, service providers, system vendors, and internal partners. |
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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. Interprets and enforces ODP regulations, waiver requirements, standards, policies, and procedures related to provider enrollment, qualification, and ongoing compliance across ODP-administered waivers. Supports the Office of Developmental Programs’ Provider Qualifications and Enrollment functions by providing central office oversight of provider qualification standards, enrollment requirements, operational procedures, and compliance monitoring activities. Leads development, revision, and implementation of policies, operational guidance, and technical bulletins related to provider qualifications, enrollment, and compliance, including coordination with internal and external stakeholders to ensure consistent statewide application. Serves as subject matter expert for provider-related system functionality across HCSIS, PROMISe®, ECM, EVV, and other applicable systems supporting provider enrollment, qualification, billing, and monitoring. Prepares and submits required CMS evidence and reporting related to waiver provider qualifications, enrollment, and compliance oversight. Prepares provider-specific and aggregate reports to inform ODP leadership, oversight entities, and quality improvement initiatives. Coordinates with Program Integrity, Financial Operations, Legal staff, and other internal partners to identify, assess, and mitigate fraud, waste, and abuse risks related to provider enrollment, qualifications, and service delivery. Develops, manages, and oversees provider monitoring frameworks, including tool development, data analysis, corrective action processes, and enforcement recommendations related to provider qualification and enrollment compliance. Identifies systemic compliance risks affecting provider enrollment and qualifications and develops mitigation strategies in collaboration with ODP regional offices, incident management, and other oversight functions. Participates in on-site and targeted monitoring reviews, including interviews with providers, participants, surrogates, and natural supports, to assess compliance with provider qualification and enrollment requirements. Leads planning and implementation of new or revised waiver requirements impacting provider enrollment, qualification, and compliance processes. Coordinates communication, training, and transition strategies to ensure readiness among providers, Administrative Entities, Supports Coordination Organizations, and participants related to provider qualification and enrollment changes. Monitors post-implementation impacts of provider-related policy or system changes and recommends programmatic or operational adjustments as needed. Develops and delivers training, guidance, and technical assistance related to provider enrollment, qualification standards, compliance expectations, and policy interpretation. Provides consultation to Administrative Entities, Supports Coordination Organizations, providers, and ODP regional staff regarding provider qualifications, enrollment processes, and compliance requirements. Represents ODP in statewide meetings, town halls, and interagency workgroups related to provider enrollment, qualifications, and oversight. Travels statewide as needed to support training, consultation, and monitoring activities. Provides technical expertise and testimony in participant and provider appeals before the Bureau of Hearings and Appeals and other forums related to provider qualifications, enrollment, billing, and compliance. Responds to complaints related to provider qualifications, enrollment, payments, and service delivery and supports development of evidentiary documentation for enforcement actions. Prepares executive briefings, reports, and recommendations related to provider performance, compliance risks, and oversight outcomes. Develops and maintains documentation of key provider enrollment, qualification, and monitoring workflows to support continuity of operations. Supports knowledge transfer, mentoring, and onboarding related to provider qualification and enrollment oversight functions. Serves as the ODP Central Office lead and subject matter expert for Participant-Directed Services (PDS), including oversight of VF/EA Financial Management Services and Agency With Choice models. Interprets and enforces federal and state requirements related to PDS models and delivery systems, ensuring consistent statewide implementation within the Consolidated, Community Living, and Person/Family Directed Support (P/FDS) waivers. Serves as the ODP Central Office lead and primary point of contact for Electronic Visit Verification (EVV) across all applicable waiver services and delivery models. Interprets, implements, and enforces federal EVV requirements, CMS guidance, and DHS/ODP policies to ensure statewide compliance and operational consistency. Leads development, revision, and implementation of PDS- and EVV-related policies, operational guidance, and technical bulletins. Oversees statewide PDS and EVV compliance monitoring, including analysis of utilization, verification rates, exception trends, manual edits, and provider compliance indicators. Develops, maintains, and reviews PDS- and EVV-related monitoring tools, dashboards, and reports to support program oversight and executive decision-making. Coordinates with Administrative Entities, Program Integrity, Financial Operations, Legal staff, system vendors, and other partners to identify and mitigate PDS- and EVV-related compliance risks. Supports enforcement activities related to PDS and EVV, including corrective action plans, sanctions, and referrals as appropriate. Provides technical assistance, training, and guidance related to PDS and EVV operations and system use. Evaluates post-implementation impacts of PDS or EVV policy and system changes and recommends programmatic or operational adjustments as needed. Represents ODP in statewide, interagency, and CMS-related meetings and workgroups related to PDS and EVV. Performs all other 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. Makes decisions related to interpretation and application of provider qualification, enrollment, and compliance policies and operational procedures with minimal supervisory consultation to ensure consistent statewide implementation. Independently reviews and evaluates provider fiscal and operational practices related to enrollment, qualification, and service delivery and resolves identified issues within established authority, including coordination with internal partners as needed. Manages provider monitoring and oversight processes related to qualifications and enrollment, including determining appropriate monitoring tools, corrective action requirements, and follow-up activities, with minimal supervisory oversight. Determines when provider compliance trends, systemic risks, or operational issues require corrective action, enhanced monitoring, policy clarification, or referral to Program Integrity, Financial Operations, or Legal staff. Makes recommendations regarding enforcement actions related to provider qualifications and enrollment, including corrective action plans, monitoring frequency, sanctions, or referrals, based on risk assessment and compliance findings. Refers matters involving significant policy shifts, novel interpretations, or elevated legal, fiscal, or programmatic risk to supervisory staff for review and direction as appropriate. Independently interprets and applies Participant-Directed Services (PDS) policies and requirements, including oversight of VF/EA and Agency With Choice models, to resolve operational, fiscal, and compliance issues with minimal supervisory consultation. Determines the interpretation and application of Electronic Visit Verification (EVV) requirements and ODP policy to operational scenarios to ensure statewide compliance and consistency. Decides when EVV compliance trends, risks, or system issues require corrective action, escalation, enhanced monitoring, or policy clarification. Makes recommendations regarding EVV enforcement actions, including corrective action plans, monitoring frequency, and referral to Program Integrity or Legal staff, based on risk assessment and compliance findings. |
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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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