GRADE
21
LOCATION OF POSITION
MDH Office of Medicaid Provider Services Baltimore MD
Main Purpose of Job
The primary purpose of the position is to direct and coordinate all activities of agency specific Medicaid programs: Policy & Compliance programs include the Telehealth Program Excluded/Sanctioned Provider Program Interoperability Rule Medicaid Regulations and the State Plan with which each state Medicaid agency must submit to CMS and receive CMS approval to enable Medicaid agencies to pull federal funds for Medicaid activitiesboth existing and evolving and as Medicaid creates new activities and oversees other Special Projects within Provider Services. For such programs this position establishes policies and procedures oversees implementation and approves revisions. It establishes and evaluates program goals standards and controls to meet program objectives. It oversees and manages the personnel (14 PINs & 11 SPPs) and financial resources of the programs and determines organizational structure and staffing needs of the programs. It develops short and long-range plans for program operations and resources. It oversees development and training of program staff and broader policy training for providers regarding enrollment and general communications. This position plans coordinates supervises and evaluates the work of subordinate supervisors. It represents the Department in a liaison capacity with managers and officials of other agencies including MSDE; MDE; OIG; MFCU; Public Health; DHS; MHCC; and CMS concerning program activities. Additionally it promotes the programs and informs interested groups and the general public including CMS CRISP HealthChoice Managed Care Organizations Maryland Hospital Association and various medical professional organizations.
Under the Provider Policy & Communications Division this position oversees and manages all Medicaid regulations State Plan Amendments (SPAs) and Provider Transmittals simultaneously ensuring compliance with SPAs to pull down federal funds; establishes overall policies procedures and oversees implementation for oversight and compliance among providers; and promotes the program by improving understanding via sub-regulatory guidance and communication to providers. Additionally the position directs and coordinates the writing of reports and represents the Department in liaison capacity in high level meetings committees and workgroups both internal and external to identify future provider policy needs and develop short and long-range plans. This position also establishes and evaluates goals and standards of highly political provider programs and coordinates as needed with OGA. Additionally this Division leads and supports various special projects as they come up within the Administration and across programs and other Administrations. Under the Medicaid Provider Compliance Program it directs and coordinates compliance related activities and evaluates broader Medicaidstandards and controls to ensure Medicaid is meeting Medicaid provider objectivesand Federal objectives to comply with audits and program integrity sanction providerrequirements. Additionally this position develops short and long-range plans foroperations by means of corrective action plans and resource planning resulting fromCMS and state audit findings and evolutions to sanction provider policy. Thisposition represents the Medicaid provider sanction actions distinct from otherMedicaid program integrity actions with officials from Office of the InspectorGeneral (OIG) the Medicaid Fraud and Compliance Unit (MFCU) and executivelevel MDH directors and secretaries regarding program activities and opportunitiesto improve Agency mission of program integrity within the provider sanctionauthority. This position evaluates the Provider Compliance Program goals andstandards to minimize risk for monetary penalties resulting from non-compliance viaaudits and engages in preventative compliance work to prevent future audit findings.
Additionally this position oversees the Long-Term Care Provider Resolution Unit(LTCPRU).The Assistant Director is responsible for planning organizing implementingadministering and supervising the interpretation and application of agency policiesdirectives and procedures designed to accomplish the mission of the agency. Thisposition is responsible for program or project review development evaluation andcoordination. This position is responsible for evaluating the efficiency of operationsand develops revises new policies standards and workflow procedures using newtechnology where appropriate; interprets and applies or oversees the application ofagency policies rules and regulations to accomplish the work of the unit or division;implements new regulations and policies as directed by upper management; setsgoals and deadlines and oversees the workflow of the unit; coordinates workflow withadministrators of other units in areas of work spanning multiple unitsadministrations and State Agencies.
This position is also responsible for overseeing or coordinating agency operationsand supervise staff comprised HPA MCPS MCPA and OSC who provide assistanceto public and private agencies regarding Medical Care Program services who areresponsible for the performance of qualitative or quantitative analysis Medical CareProgram with a knowledge of principles of health care policies and theadministration and practices to audit analyze and interpret health care reports anddocuments to effectively prohibit incorrect/inaccurate reimbursement and protectthe health and safety of Medicaid/Medicare participants. The position is responsiblefor tracking and implementing process improvements and best practices. Theposition work closely across other MDH and DHS to successfully implement policiesand procedures and maintain the program integrity. This position works as theliaison with internal and external stakeholders on provider addition thisposition is responsible for high priority policy analysis of recipient eligibilityprovider payments and enrollment including controlled correspondence weeklyreports and advising senior MDH staff with policies budgets and cost savingsanalysis.
MINIMUM QUALIFICATIONS
Qualified candidates should possess a Bachelors degree from an accredited college or university and six years of health or human services administrative or professional experience including three years at a supervisory or managerial level. A Masters degree from an accredited college or university will substitute for one year of the general experience and a Doctorate will substitute for two years of the general experience. Additional experience will substitute on a year-for-year basis for the college degree.
DESIRED OR PREFERRED QUALIFICATIONS
Desired candidates should possess:
1. Expertise and oversight of Medicaid Regulatory Promulgation Process
2. Experience with a State Medicaid Agency in Provider Compliance related activities
3. Experience and oversight of Medicaid LTCPRU activities
SELECTION PROCESS
This is a Management Service position and serves at the pleasure of the Appointing Authority. A Resume must be uploaded to the application.
Applicants who meet the minimum (and selective) qualifications will be included in further evaluation. The evaluation may be a rating of your application based on your education training and experience as they relate to the requirements of the it is essential that you provide complete and accurate information on your report all related education experience dates and hours of indicate your college degree and major on your application if applicable. For education obtained outside the U.S. any job offer will be contingent on the candidate providing an evaluation for equivalency by a foreign credential evaluation service prior to starting employment (and may be requested prior to interview).
Complete applications must be submitted by the closing submitted after this date will not be added.Incorrect application forms will not be accepted.
Candidates may remain on thecertified eligible list for a period of at least one year. The resulting certified eligible list for this recruitment may be used for similar positions in this or other State agencies.
BENEFITS
FURTHER INSTRUCTIONS
Online applications are highly recommended. However if you are unable to apply onlinethe paper application (and supplemental questionnaire) may be submitted to MDH Recruitment and Selection Division 201 W. Preston St. Room 114-B Baltimore MD application materials must be received by 5 pm close of business on the closing date for the recruitment no postmarks will be accepted.
If additional information is required the preferred method is to upload. If you are unable to upload please fax the requested informationto .Only additional materials that are required will be accepted for this recruitment. All additional information must be received by the closing date and time.
For questions regarding this recruitment please contact theMDH Recruitment and Selection Division at .
If you are having difficulty with your user account or have general questions about the online application system please contact the MD Department of Budget and Management Recruitment and Examination Division at or.
Appropriate accommodations for individuals with disabilities are available upon request by calling: or MD TTY Relay Service 1-.
We thank our Veterans for their service to our country.
People with disabilities and bilingual candidates are encouraged to apply.
As an equal opportunity employer Maryland is committed to recruitment retaining and promoting employees who are reflective of the States diversity.
Job Location:
Monthly Salary:
Not Disclosed
Posted on:
Yesterday
Vacancies:
1 Vacancy
