DMHAS Health Care Policy Program Director

The State of Connecticut, Department of Mental Health and Addiction Services (DMHAS) is a health care agency whose mission is to promote the overall health and wellness of persons with behavioral health needs through an integrated network of holistic, comprehensive, effective, and efficient services and supports that foster dignity, respect, and self-sufficiency in those we serve.

Are you looking for a challenging role in Health Care Policy? If so, we have the position for you! The Office of the Commissioner (OOC) seeks an experienced and qualified individual for a meaningful role as a DMHAS Health Care Policy Program Director (PCN: 118143), within our Fiscal Services Division. This position is full-time 40 hours per week. The work schedule is Monday - Friday, 8:00 am - 4:30 pm., and will be located at 410 Capitol Avenue, Hartford, CT.

• Manage billing operations for DMHAS services for approximately $50 million in Medicaid and Medicare revenue annually while ensuring compliance with changes to state/federal requirements;
• Promote revenue enhancement through provider/staff education and training;
• Manage revenue design, procedural revisions and implementation of new federal Medicaid opportunities through interdepartmental initiatives;
• Manage claims and revenue analysis, projections and reporting for internal and external customers and serve as liaison to Department of Administrative Services, Department of Social Security, Office of Personnel Management and auditors for over $100 million in Disproportionate Share Hospital reimbursements;
• Manage the Billing Unit in the Office of the Commissioner and provide guidance and oversight on revenue and billing-related activities to DMHAS operated facilities.

We participate in a competitive benefits plan that includes healthcare coverage, a retirement plan, as well as, paid time off! We offer outstanding work/life balance and limitless opportunity!

This posting may require completion of additional referral questions (RQs) which will be sent to you via email after the closing date. The email notification will include an expiration date by which you must submit (Finish) your responses. Please regularly check your email for notifications. Please check your SPAM and/or Junk folders, as emails could end up there in error.

This position will be filled in accordance with contractual language, reemployment, SEBAC, transfer, promotion and merit employment rules. Candidates who meet the Minimum Qualifications - as listed on the job opening - will be considered for this role, as determined by qualifications stated on the submitted application.

The minimum experience and training requirements must be met by the close date on the job opening, unless otherwise specified.

Due to the volume of applications anticipated, we are unable to provide confirmation of receipt or status during the recruitment process. Updates will be provided through your JobAps portal account.

Interviews will be limited to candidates whose experience most closely meet the preferred requirements of the position. Applicants invited to interview may be required to submit additional documentation, which supports their qualification(s) for this position. These documents may include: performance reviews, supervisory references, college transcripts, licensure, etc., at the discretion of the hiring agency.

Please Note: You will be unable to make revisions once you submit your application for this posting to the JobAps system.

Should you have questions regarding this recruitment please contact Andrew Pebley at Andrew.Pebley@ct.gov or (860) 785-6185.

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.

• Experience interpreting state laws and Medicaid regulations;
• Experience researching CMS/Medicare regulations;
• Experience interpreting claims/revenue data and its impact on projected revenue;
• Experience leading, guiding and monitoring large groups, staffed from a variety of disciplines and locations, to work together to meet the billing needs of the department;
• Experience enrolling individual, clinic, and hospital providers in Medicaid and Medicare;
• Excel skills including ability to use functions such as vlookups, sumifs and pivot tables and ability to analyze thousands of data records to, for example, quantify the impact of policy changes or to identify billing issues.