$44.97-$61.32 Hourly / $3,597.55-$4,905.25 BiWeekly /
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 direction from the Chief of Fiscal/Administrative Services or other administrative official of higher grade.
Directs staff and operations of a healthcare finance or billing unit; coordinates, plans and manages unit activities; formulates program goals and objectives; develops or assists in development of related policy; establishes and maintains unit procedures; manages development of new program initiatives involving financial and cost analysis, rate setting, billing and cost containment or recovery; initiates, interprets and administers pertinent laws; evaluates staff; maintains contacts with individuals both within and outside unit who might impact on program activities including insurance and managed care providers; coordinates within and outside agency regarding billing and revenue data, Medicare Cost report information and related data; assists in planning and implementation of financial and billing aspects of managed care programs; prepares and analyzes complex financial statements, reports and budget requests; projects expenditures and assists in financial planning; prepares revenue projections 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; manages staff and activities for purpose of obtaining maximum reimbursement; provides training and education to managed care providers to ensure billing requirements are met; ensures managed care provider compliance allowing for federal reimbursement for services rendered; analyzes and interprets federal and state laws and regulations as they pertain to rate setting and revenue and/or reimbursement; conducts data analysis of claims payments, analysis of services billed/not billed and payments made/not made; coordinates re-billing with the Department of Administrative Services; oversees setup of service codes, insurances, diagnosis code updates and other billing related tables; 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.
Considerable knowledge of and ability to apply management principles and techniques; considerable knowledge of and ability to apply relevant state and federal laws, statutes and regulations; considerable knowledge of principles of health care administration, financial management and billing administration; considerable knowledge of health care budgeting principles; considerable knowledge of principles of cost analysis; considerable interpersonal skills; considerable oral and written communication skills; considerable ability to prepare and interpret financial and statistical reports.
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 the Special Experience is interpreted as one (1) year of experience at the level of Fiscal Administrative Supervisor performing health care cost analysis or Principal Health Care Analyst.