In the Department of Mental Health and Addiction Services this class is accountable for directing the determination of reimbursement rates for contracts negotiated by the department for the provision of behavioral health services or coordination of all revenue reimbursement efforts.
Receives administrative direction from the Chief of Fiscal/Administrative Services or other administrative official of higher grade.
Directs staff of unit as assigned.
EXAMPLES OF DUTIES
Directs staff and operations of a healthcare finance or billing unit;
Coordinates, plans and manages unit activities including contact with insurance and managed care providers regarding billing and revenue data, Medicare Cost report information and related data to ensure obtaining maximum revenue and/or reimbursement;
Formulates program goals and objectives;
Develops or assists in development of related policy and procedures;
Initiates, interprets and administers pertinent laws;
Maintains contacts with individuals within and outside of unit who might impact program activities;
Manages development of new program initiatives involving financial and cost analysis, rate setting, billing and cost containment or recovery;
Assists in planning and implementation of financial and billing aspects of managed care programs;
Prepares and analyzes complex financial statements, reports and budget requests;
Prepares revenue projections including expenditures and analyzes agency changes for impact on revenue;
Analyzes and provides information on impact of agency policies, staffing and treatment protocols on rates and revenue and/or reimbursement;
Provides training and education to managed care providers to ensure meeting billing requirements;
Ensures managed care provider compliance allowing for federal reimbursement for services rendered;
Analyzes and interprets federal and state laws and regulations relevant to rate setting and revenue and/or reimbursement;
Conducts data analysis of claims payments, analysis of services billed and/or not billed and payments made and/or not made;
Coordinates re-billing with Department of Administrative Services;
Oversees setup of service codes, insurances, diagnosis code updates and other billing related tables;
Leads the recruitment and hiring of staff, including outreach, interview and selection;
May negotiate agreements for medical care services with professional groups and service providers;
May testify at legislative hearings regarding agency efforts to set rates and expand sources of revenue;
Performs related duties as required.
KNOWLEDGE, SKILL AND ABILITY
Considerable knowledge of
and ability to apply management principles and practices;
relevant state and federal laws, statutes and regulations;
principles of health care administration, financial management and billing administration;
health care budgeting principles;
principles of cost analysis;
oral and written communication skills;
Considerable ability to prepare and interpret financial and statistical reports.
MINIMUM QUALIFICATIONS - GENERAL EXPERIENCE
Nine (9) years of experience in cost accounting, cost analysis, financial management or policy analysis for revenue maximization.
MINIMUM QUALIFICATIONS - SPECIAL EXPERIENCE
One (1) year of the General Experience must have been in a supervisory capacity over professional staff involved in health care cost analysis.
NOTE: For state employees this experience is interpreted at the level of a Fiscal Administrative Supervisor performing health care cost analysis or Principal Health Care Analyst.
MINIMUM QUALIFICATIONS - SUBSTITUTIONS ALLOWED
College training may be substituted for the General Experience on the basis of fifteen (15) semester hours equalling one half (1/2) year of experience to a maximum of four (4) years for a Bachelor's degree.
A Master’s degree in a closely related field may be substituted for one (1) additional year of the General Experience.
A law degree may be substituted for one (1) additional year of the General Experience.
JOB CLASS DESIGNATION
(1)-Officials And Administrators
As defined by Sec. 5-196 of the Connecticut General Statutes, a job class is a position or group of positions that share general characteristics and are categorized under a single title for administrative purposes. As such, a job class is not meant to be all-inclusive of every task and/or responsibility.
This replaces the existing specification for the class of DMHAS Health Care Policy Program Director in Salary Group MP 67 approved effective February 1, 2018. (Revised to add Acknowledgement section and modify content) Final No. 23-001