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Commonwealth of Pennsylvania |
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POSITION DESCRIPTION FOR JOB POSTING |
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Position Number: 00212885 |
Description Activated On: 3/20/2026 10:50:32 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 position provides rate and budget support for PA’s Physical Health HealthChoices program to ensure that the rates paid to our PH contractors reflect negotiated terms, are adequately budgeted, and are paid timely and accurately. Compensation is paid by the Department to Managed Care Organizations (MCOs) for providing Medical Assistance (MA) benefits to MA recipients enrolled in their HealthChoices managed care plan. Capitation payments are the primary source of this compensation. PA’s Physical Health HealthChoices program operates in all 67 counties, which are divided into five geographic zones. The position develops rate appendices showing contracted capitation rates and other payment provisions. The position also aids in preparing budget requests to project expenditures related to these contracted terms. 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. The position is located in the Office of Medical Assistance Programs (OMAP), Bureau of Fiscal Management (BFM), Division of HealthChoices Rates, who receives supervision and direction from the Fiscal Management Specialist (FMS 3). The incumbent performs analytical responsibilities which require a considerable degree of initiative and judgment. Most of the job duties listed below involve preparing and updating enhanced Excel spreadsheets with multiple worksheets, links to other files, complex formulas, and pivot tables. •Rate Development. For the assigned HealthChoices zones, the position develops capitation rates for the MCOs operating within those zones in accordance with decisions by OMAP and BFM management. Prepares analyses of rate ranges provided by our actuarial consultant. Maintains documentation underlying these calculations. Prepares contract appendices that establish our payment obligation to the MCOs operating within the assigned zones. Assists in explaining and discussing rate projects and components of rates in meetings with DHS management and MCOs. •Reporting. Calculates and reports payment obligations created by the HealthChoices agreements including Maximum MCO Pay for Performance amounts, the Hospital Assessment, and Access to Care payments. Maintains documentation underlying these calculations. Drafts correspondence related to these obligations, including answering questions as needed. Prepares Projections of Expenditure for the assigned zones to support the annual CMS Rate Certification. •Budget development. Develops assigned zones’ cost estimates to include in the budget requests for the Physical Health portion of the Capitation appropriation. Tracks expenditures in the capitation appropriation. •Enrollment Projections. Projects future managed care enrollment for assigned HealthChoices zones. These projections are used for the budget requests, rate setting, waiver cost effectiveness, and other purposes. This entails analyzing enrollment data by geography and demographic factors to discover patterns and trends. Compares projected enrollment to actual results. Determines the reasons for, and the financial impact of the variances. •Data Analysis. Compiles assigned zones’ historical enrollment and payment data for use by our actuarial consultant in rate setting and for projecting future enrollment. Organizes and analyzes data which may involve reviewing budget information or applying mathematical, systems, or statistical methods to analyze data in order to draw conclusions, make recommendations and suggest program alternatives for higher level decision making. Analyzes and prepares data used to develop the cost effectiveness portion of the federal waiver requests. Develops written results and documentation of assigned analytical projects for use by upper management and others. Prepares tables and graphs from analysis of data for inclusion in final work products which may be presented orally, in writing, or in the form of narrative or statistical reports. •Rate Payment. Participates in meetings related to payment issues. Computes retroactive rate adjustments for assigned zones. Ensures appropriate rates are activated. Coordinates with other Commonwealth staff to ensure timely activation of rates. Maintains record keeping of the rates that are input to the Payment System. •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. Related duties as required. This includes but is not limited to: •Developing and maintaining project timelines, to include critical tasks or paths, and evaluating progress toward project goals. • Peer reviewing calculations of other Analysis Management Section or Division staff through proofing steps and documentation. • Preparing ad-hoc reports |
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. In the areas outlined above, the position develops work plans, has input into methodologies to use, and prioritizes assignments independently when feasible. The incumbent is encouraged to use new methodologies and data sources in addition to established practices and procedures and provides recommendations to the Section Supervisor. For issues of uncertainty or in new/different situations, the position receives guidance from the Section Supervisor or Division Director for a decision to be made at a higher level of management. |
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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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