The incumbent will manage the DMMA Reimbursement Unit. Duties include researching and managing Medicaid Fee For Service (FFS) rates and methodologies; Interpreting state and federal Medicaid reimbursement policies, regulations and laws; developing new Medicaid reimbursement methodologies; capitation rate forecasting for federal and state share cost; data mining from various system databases. This position manages two staff members in the reimbursement unit.
Essential functions are fundamental, core functions common to all positions in the class series and are not intended to be an exhaustive list of all job duties for any one position in the class. Since class specifications are descriptive and not restrictive, incumbents can complete job duties of similar kind not specifically listed here.
- Serves as Department's technical expert in the highly complex areas of health care cost containment.
- Manages, directs and/or performs specialized studies which result in alternative health care delivery systems and methodologies. Supervises staff as needed when directing any project.
- Provides technical expertise to other Divisions, within the Department, in the areas of policy development, research and evaluation, reimbursement methodologies and health care cost containment initiative.
- Collects and analyzes varied and complex data used in support of report, project and funding development purposes.
- Serves on or coordinates special committees, task forces, and working groups involved in strategic planning, policy development, service delivery and cost containment projects for the Department.
- Analyzes reports and documents from federal, state and the department and recommends cost containment policy changes.
- Prepares annual legislative Health Care Cost Containment Report which outlines the Department activities in this area.
- Keeps abreast of legislative and technical developments and change related to the area.
- Works with other state, local or private agencies that are affected by cost containment policy changes
JOB REQUIREMENTS for Health Care Cost Containment Specialist
Applicants must have education, training and/or experience demonstrating competence in each of the following areas:
- Three years experience in health care cost containment such as analyzing health care costs and recommending delivery systems and reimbursement procedures.
- Six months experience in developing policies and procedures.
- Six months experience in interpreting health care laws, rules, regulations, standards, policies and procedures.
- Six months experience in health or human services program administration such as overseeing and directing the development, implementation and evaluation of health or human services programs and services; planning and establishing short and long range program goals and objectives. Providing advice to other agency organizational units through consultation.
- Knowledge of managing budgets, grants or contracts.
- Knowledge of staff supervision acquired through course work, academic training, training provided through an employer, or performing as a lead worker overseeing the work of others; OR supervising staff which may include planning, assigning, reviewing, and evaluating the work of others; OR supervising through subordinate supervisors a group of professional, technical, and clerical employees.
The application and supplemental questionnaire are evaluated based upon a rating of your education, training and experience as they relate to the job requirements of the position. It is essential that you provide complete and accurate information on your application and the supplemental questionnaire to include dates of employment, job title and job duties. For education and training, list name of educational provider, training course titles and summary of course content. Narrative information supplied in response to the questions must be supported by the information supplied on the application including your employment, education and training history as it relates to the job requirements.
Once you have submitted your application on-line, all future correspondence related to your application will be sent via email. Please keep your contact information current. You may also view all correspondence sent to you by the State of Delaware in the “My Applications” tab at www.delawarestatejobs.com.
Accommodations are available for applicants with disabilities in all phases of the application and employment process. To request an auxiliary aid or service please call (302) 739-5458. TDD users should call the Delaware Relay Service Number 1-800-232-5460 for assistance. The State of Delaware – An Equal Opportunity and Affirmative Action Employer.