POSITION DESCRIPTION

Transcription

1 State of Michigan Civil Service Commission Capitol Commons Center, P.O. Box Lansing, MI Position Code 1. STDDADM1P21N POSITION DESCRIPTION This position description serves as the official classification document of record for this position. Please complete the information as accurately as you can as the position description is used to determine the proper classification of the position. 2. Employee's Name (Last, First, M.I.) 8. Department/Agency MDHHS-COM HEALTH CENTRAL OFF 3. Employee Identification Number 9. Bureau (Institution, Board, or Commission) Medicaid Operations and Actuarial Services 4. Civil Service Position Code Description 10. Division State Administrative Manager-1 Third Party Liability 5. Working Title (What the agency calls the position) 11. Section Section Manager Financial Recovery 6. Name and Position Code Description of Direct Supervisor 12. Unit HONSOWITZ, KEELIE K; STATE DIVISION ADMINISTRATOR 7. Name and Position Code Description of Second Level Supervisor 13. Work Location (City and Address)/Hours of Work KEISLING, BRIAN L; STATE BUREAU ADMINISTRATOR S. Pine St., Lansing, MI / Monday - Friday, 8a - 5p 14. General Summary of Function/Purpose of Position This position will serve as the Section Manager over the Financial Recovery Section. This position will direct the planning, development and implementation of Third Party Liability (TPL) recovery related activities for the Medicaid Program. This position will be responsible for all division financial duties including, but not limited to, internal and external Division Activity reports, early Accrual Reports, and financial transaction reporting for all TPL Division activities. The Section manager provides oversight and assists with strategic planning for all Health Recovery activities. This would include payer communications, assistance with validation of HIPAA files, subrogation claim rejection reviews and dashboard monitoring and reporting. This position also includes all security and vendor management activities that are a part of the Financial Recovery Section. Coordination of contracts and statements of work, system security and user tools is a part of the daily oversight for this position. This position will monitor the coordination between contracted system staff and all technology partners to ensure that all federal rules and regulations are met.

2 15. Please describe the assigned duties, percent of time spent performing each duty, and what is done to complete each duty. List the duties from most important to least important. The total percentage of all duties performed must equal 100 percent. Duty 1 General Summary: Percentage: 40 Planning and development to encompass changes in the health care industry. Manage, monitor, and direct section-related activities. Interpret applicable laws, related statues, case law and legal opinions, which govern course of action. Evaluate proposed and final state and federal legislation or regulations for their fiscal impact on the division. Propose statutory amendments to improve section operations. Review applicable portions of the State Plan to monitor section compliance and suggest needed changes. Direct the resolution of major health insurance subrogation issues with Medicare and commercial carriers. Participate in the development of new national initiatives relative to health insurance billing, technical records and data element definitions to improve health recovery processes. Coordinate directly with insurance payers to establish direct billing relationships. Establish long-term and short-term goals consistent with the Department s direction in health care planning. Develop new initiatives to meet these goals. Design and implement methods to accomplish goals within the established time periods. Determine impact and system implications from new policy implementation. Advise departmental and outside persons of the functions, regulations, and policies of the work area. Review and approve responses to complex inquiries regarding section activities. Evaluate existing or proposed policies and procedures to identify existing or potential conflicts of policy. Assist in the development and maintenance of management controls to ensure section activities are responsive, efficient and effective. Collaborate with other areas outside of TPL, the current TPL vendor, consulting firms, Medicaid Health Plans, health insurance companies and third party administrators to improve current section processes and develop new processes to increase efficiency. Oversight of the contract managers processes, including vendor vouchers, refunds, and other financial transactions. Analyze ongoing vendor operations and direct and participate in the development and evaluation of vendor policies and procedures related to health insurance recoveries. Liaison with DTMB security management. Assist with audit examinations and work with section staff to address any identified issues. Direct and participate in the development of section procedure manuals. Form and facilitate work groups to examine processes and ensure program effectiveness. Maintains records of section activities and prepares and presents reports to division manager. Research and respond to inquiries from the Center of Medicare and Medicaid Services (CMS) and federal and state auditors related to section activities. Duty 2

3 General Summary: Percentage: 25 Responsible for oversight of all TPL Division financial transactions and year end closing. Direct the revision of rules, regulations, and procedures to meet changes in law or policy for all financial reporting. Confer with officials of federal, state, and local agencies, legislators, governor s aides, professional organizations, and interest groups on matters relating to TPL financial data. Develop policy and procedures relative to processing TPL related checks. Develop policy and procedures relative to issuing payment vouchers. Liaison with Accounting and Budget office. Direct the guidelines for the Division monthly financial activity report and corresponding documentation. Monitor and evaluate the TPL Division s cash flow to improve efficiency, improve effectiveness, and resolve outstanding transactions. Direct the compilation and preparation of data for financial studies. Develop and provide division financial reporting or assessments as needed. Manage year end closing by ensuring staff have balanced receipts and payments processed by the division against the TPL suspense account. Develop, test, and implement needed financial enhancements to TPL related systems. Evaluate and approve yearly estimated TPL accrual report. Duty 3 General Summary: Percentage: 20 Manage and direct section staff.

4 Coordinate activities by scheduling work assignments, setting priorities, and directing the work of employees. Evaluate and verify employee performance by monitoring activities to assure desired quantities, quality, and outcome of the section s efforts. Conduct performance management reviews. Ensure that proper labor relations and conditions of employment are maintained. Select and recommend for hiring and/or promotion candidates for new and/or vacant positions using the department s established hiring criteria ensuring equal employment opportunity. Advocate and negotiate for adequate system and staff resources. Responsible for timekeeping and the approval of leave requests. Implement policies and procedures necessary to ensure positive outcomes. Develop Section procedure manuals. Maintain records of section activities and prepare and present reports to division manager. Conduct staff meetings on a regular basis. Develop goals and objectives for the Section. Identify, secure and/or provide training to ensure adequate staff performance and development. Select, administer, and document progressive and corrective disciplinary measures, as needed. Conduct formal/informal counseling, as needed. Duty 4 General Summary: Percentage: 10 Coordinate project maintenance and development of data warehouse activities and various automated systems as it relates to Section activities. Review and approve technical and/or program development documentation received from various sources, including data transfers vendors and other entities regarding existing projects. Interact with program, vendors, and other entity staff via telephone, written correspondence, and/or face-to-face meetings to analyze and resolve system and/or data warehouse operational issues. Direct and participate in the development of new project documentation, which may include project proposals with budget, resource and timeframe estimates in addition to procedure manuals and contract requests for proposal. Ensure system and data warehouse activities meet state and federal regulations and requirements as well as data integrity standards. Oversee the design, development, testing and implementation of new modules for the TPL Electronic Database (TED) that impact the Section. Monitor and evaluate CHAMPS TPL functions to assist in the design of necessary enhancements and corrections. Duty 5 General Summary: Percentage: 5 Other related work as assigned.

5 Develop section research as needed. Develop new initiatives to increase recovery opportunities. Design and implement pilot projects. Perform related work as assigned. Complete ad hoc reporting as assigned. Represent the division on workgroups as requested and report outcomes. 16. Describe the types of decisions made independently in this position and tell who or what is affected by those decisions. Resolve controversies between insurance companies and other entities when attempting to recovery subrogation reclamation claims. Determine appropriate financial data collection methods. Provide written or verbal response to internal and external inquiries relative to current practice. The position will also independently make decisions on the design of the various automated systems and provide written or verbal response to internal and external inquiries relative to current practice. Incorrect analysis can result in incorrect reporting, including federal reporting, which could result in penalties. Incorrect responses to current practice inquires will result in misunderstanding of section practices and procedures. The impacts of all of these decisions involve millions of dollars in revenue, lost or gained by the State of Michigan. 17. Describe the types of decisions that require the supervisor's review. Decisions that could change or effect policies of TPL or other areas within the department. 18. What kind of physical effort is used to perform this job? What environmental conditions in this position physically exposed to on the job? Indicate the amount of time and intensity of each activity and condition. Refer to instructions. Normal office environment. Sitting for long periods (75% of the day). Occasional bending, lifting, and/or walking (25% of the day). 19. List the names and position code descriptions of each classified employee whom this position immediately supervises or oversees on a fulltime, on-going basis. FECKO, LAUREN K NAME CLASS TITLE NAME CLASS TITLE DEPARTMENTAL ANALST- A 12 HAMELINK, LORI A DEPARTMENTAL ANALST- A 12 POTTER, ANDREW W FINANCIAL ANALST-E P11 CAPUTO, SABATO A DEPARTMENTAL ANALST- A 12 LOVELL, ROBERT L Additional Subordinates DEPARTMENTAL TECHNICIAN-E E9 VACANT FINANCIAL SPECIALIST This position's responsibilities for the above-listed employees includes the following (check as many as apply): Complete and sign service ratings. Assign work. Provide formal written counseling. Approve work. Approve leave requests. Review work. Approve time and attendance. Provide guidance on work methods.

6 Orally reprimand. Train employees in the work. 22. Do you agree with the responses for items 1 through 20? If not, which items do you disagree with and why? Management prepared. 23. What are the essential functions of this position? Operational oversight of the section, including research, design, develop and implement financial and health insurance related strategies to improve section recovery activities. 24. Indicate specifically how the position's duties and responsibilities have changed since the position was last reviewed. New position. 25. What is the function of the work area and how does this position fit into that function? Identification and pursuit of legally liable third party resources as directed by federal regulations. Maximize state revenue by pursuing liable third party resources for recovery of Medicaid expenditures. This position is responsible to effectively manage the division s financial components and provide administrative support to the division as a whole. 26. What are the minimum education and experience qualifications needed to perform the essential functions of this position. EDUCATION: Possession of a bachelor s degree in any major. EXPERIENCE: State Administrative Manager 15 Four years of professional experience, including two years equivalent to the experienced (P11) level or one year equivalent to the advanced (12) level. Alternate Education and Experience State Administrative Manager 15 Education level typically acquired through completion of high school and two years of safety and regulatory or law enforcement experience at the 14 level; or, one year of safety and regulatory or law enforcement experience at the 15 level, may be substituted for the education and experience requirements. KNOWLEDGE, SKILLS, AND ABILITIES: Thorough knowledge of financial practices. Knowledge of Medicaid and Medicare policies and reimbursement methodologies would be useful. Ability to deal with people in a professional manner and communicate effectively. CERTIFICATES, LICENSES, REGISTRATIONS: None NOTE: Civil Service approval does not constitute agreement with or acceptance of the desired qualifications of this position. I certify that the information presented in this position description provides a complete and accurate depiction of the duties and responsibilities assigned to this position. Supervisor Date

7 TO BE FILLED OUT B APPOINTING AUTHORIT Indicate any exceptions or additions to the statements of employee or supervisors. None I certify that the entries on these pages are accurate and complete. NAUSHI SMITH Appointing Authority 4/25/2018 Date I certify that the information presented in this position description provides a complete and accurate depiction of the duties and responsibilities assigned to this position. Employee Date