Medicaid Program Manager 3

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Medicaid Program Manager 3

Salary

$6,271.00 - $12,296.00 Monthly

Location

Baton Rouge, LA

Job Type

Classified

Job Number

MVA/SP/204113

Department

LDH-Medical Vendor Administration

Opening Date

01/07/2025

Closing Date

1/12/2025 11:59 PM Central

• Description

• Benefits

Supplemental Information

The Louisiana Department of Health is dedicated to fulfilling its mission through direct provision of quality services, the development and stimulation of services of others, and the utilization of available resources in the most effective manner.

LDH serves as a model employer for individuals with disabilities.

This position is located within the Louisiana Department of Health / Medical Vendor Administration / Rate Setting and Audit / East Baton Rouge Parish

Announcement Number: MVA/SP/204113

Cost Center: 3052120201

Position Number: 50456447

This vacancy is being announced as a Classified position and may be filled as a Probationary appointment, Promotional appointment or Detail to Special Duty.

No Civil Service test scoreis required in order to be considered for this vacancy.

To apply for this vacancy, click on the “Apply” link above and complete an electronic application, which can be used for this vacancy as well as future job opportunities. Applicants are responsible for checking the status of their application to determine where they are in the recruitment process. Further status message information is located under the Information section of the Current Job Opportunities page.

Resumes WILL NOT be accepted in lieu of completed education and experience sections on your application. Applications may be rejected if incomplete.

A resume upload willNOTpopulate your information into your application. Work experience left off your electronic application or only included in an attached resume is not eligible to receive credit

For further information about this vacancy contact: Shambrielle PoolerShambrielle.Pooler@la.govLDH/HUMAN RESOURCES BATON ROUGE, LA 70821 This organization participates in E-verify, and for more information on E-verify, please contact DHS at 1-888-464-4218.

Minimum Qualifications

MINIMUM QUALIFICATIONS:

Eight years of experience in developing, managing, or evaluating health or social service programs; or in public health, public relations, social services, health services, health regulation, or administrative services; OR

Six years of full-time work experience in any field plus five years of experience in developing, managing, or evaluating health or social service programs; or in public health, public relations, social services, health services, health regulation, or administrative services; OR

A bachelor’s degree plus five years of experience in developing, managing, or evaluating health or social service programs; or in public health, public relations, social services, health services, health regulation, or administrative services; OR

An advanced degree or a Juris Doctorate plus four years of experience in developing, managing, or evaluating health or social service programs; or in public health, public relations, social services, health services, health regulation, or administrative services.

EXPERIENCE SUBSTITUTION:

Every 30 semester hours earned from an accredited college or university will be credited as one year of experience towards the six years of full-time work experience in any field. The maximum substitution allowed is 120 semester hours which substitutes for a maximum of four years of experience in any field.

Job Concepts

Function of Work:

To direct large and very complex Medicaid program(s).

Level of Work:

Administrator.

Supervision Received:

Administrative direction from a higher-level administrator/executive.

Supervision Exercised:

Supervision over lower-level positions in accordance with the Civil Service Allocation Criteria Memo.

Location of Work:

Department of Health and Hospitals.

Job Distinctions:

Differs from Medicaid Program Manager 2 by responsibility for directing large and highly complex Medicaid program(s) and supervision exercised.

Differs from Medicaid Program Manager 4 by the absence of serving as the Section Chief administrating all functions of large and complex Medicaid program(s) and supervision exercised.

Examples of Work

This is a highly complex, professional management position in the Rate Setting and Audit (RS& A) Section of the Bureau of Health Services Financing (BHSF). The Rate Setting and Audit section is responsible for the administrative oversight of the cost report audit process of Intermediate Care Facilities (ICFs), Adult Day Health Center (ADHC), Nursing Facilities, and Psychiatric Residential Treatment Facilities (PRTF) as well as Minimum Data Set (MDS) reviews. The Rate Setting and Audit Section has oversight of all recoupments and penalty enforcement resulting from direct care, updated acuity, delinquent cost report filing, etc. The section oversees payment reconciliations with fiscal division, Hospital DSH and Hospital UPL, Professional Services UPL payment processing, Ambulance UPL payment processing, Outlier payments, Inpatient Graduate Medical Education (GME), Hospital and Rural Health Center (RHC) cost reporting, Annual DSH Audit, Outpatient Cost to Charge Ratios (CCR), and Medicaid inpatient utilization rate (Ml UR). The section is also responsible for rate setting for Federally Qualified Health Centers (FQHC) and Rural Health Centers (RHC). In addition to these responsibilities, the section assists with rule making, reporting performance indicators, operational planning, and the administration of both Ambulance and Hospital Assessments.

These programs require rapidly changing, complex, technical and diverse reimbursement systems involving various offices within LDH, contracted audit agencies, a multitude of state and federal laws and regulations, nearly $3 billion in expenditures, and over 1,000 providers in unique reimbursement programs. Successful administration of these payment programs necessitates constant interim monitoring, projections, analyses and meetings with federal, state and contracted auditors. Technical comprehensive and detailed analyses are prepared and constantly updated to ensure maximum funding to the Agency.

The Rate Setting and Audit section works closely with the Medicaid Leadership Team, Louisiana Department of Health Leadership Team, U.S. Department of Health and Human Services Centers for Medicare and Medicaid Services (CMS), the Division of Administration Budget Office, the Legislative Fiscal Office, the Office of the Legislative Auditor, the Office of the Inspector General, The Office of the Attorney General and other state and federal agencies in conjunction with compliance with state and federal laws, regulations, rules and guidelines as they relate to programmatic integrity and reimbursement issues.

Under the supervision of the Medicaid Program Manager 4, the incumbent performs the following duties:

35% Directs and manages the functions of the Rate Setting and Audit Section in the administration, development ,maintenance and monitoring of reimbursement policies including development of rates, administration of cost settlements to and from providers ,issues regarding hospital services, nursing facilities, intermediate care facilities (ICF's), adult day health center (ADHC), psychiatric residential treatment facilities (PRTF) recoupments of overpayments to providers and development of rules. Direct operations of the Rate Setting and Audit Section in the performance of special audits. Corresponds and meets with BHSF administrative staff to assess personnel requirements. Directs and analyzes programmatic and fiscal impact studies of reimbursement methodologies and recommends appropriate action to Rate Setting and Audit Section Chief, Medicaid Deputy Director-CFO, Medicaid Director, and Hospital and Facility Finance Director.

30% Preforms liaison functions by responding and directing responses in writing and by telephone to providers, provider associations, legislators, attorneys, consultants, state and federal agencies, program recipients and other interested parties regarding reimbursement issues. Coordinate with the Medicaid Policy and Compliance Section Chief i n preparation and submission of Medicaid State Plan Amendments to CMS. Corresponds and meets with CMS to assure federal approval of these State Plan Amendments. Coordinate with LDH 's budget staff to ensure maximization of the Department's federal fond participation. Communicate with federal regulatory agencies to assure compliance with federal laws, rules and regulations regarding program changes, enhancements and integrity.

Develops and coordinates LOH departmental responses to legislative auditors and CMS reviews of the Department’s reimbursement programs and policies. This may involve negotiation and persuasion on specific audit findings. Convenes administrative reviews requested by providers related to program and reimbursement issues in conformity with requirements of Louisiana’s Administrative Procedures Act. Direct Rate Setting and Audit activities in cooperation with the LOH Bureau of Legal Services in areas of administrative appeals and lawsuits.

15% Supervises and directs the work of high-level professional staff in the daily performance of functions under the scope of direct supervision and evaluate employee job performance. Recommends and initiates activities regarding staff management in the areas of appointments, promotions, disciplinary actions and dismissals. Identifies staff development needs and ensures appropriate training is obtained. Conducts staff meetings to provide guidance and expertise on projects, programmatic policy issues, organization, budgetary matters, personnel issues and technical problems. Established work schedules and priorities to ensure that the section's activities related to Bureau's programmatic budget are performed in a timely and efficient manner.

15% Reviews pol icy changes and participates in committee discussions and decisions to establish, enhance, amend, or abate new and current Title XIX (Medicaid) programs to assess the fiscal impact of implementation and to provide recommendations to the Section Chief, Medicaid Deputy Director-CFO, Medicaid Director and the Hospital and Facility Finance Director regarding viable funding mechanism that are in compliance with state and federal guidelines. Interprets and applies CMS guidelines applicable to programmatic funding methodology and appropriately assesses the impact of any changes to applicable guidelines. Within frequently changing federal mandates, reimbursement policies must be established based on availability of uncertain state and federal funding while meeting federal guidelines for participation and delivery of services in the Federal Medicaid program. Reviews federal mandates and consults with appropriate state and federal staff regarding state implementation of these mandates. Directs development of requests for proposals negotiates and administers audit contracts with outside agencies in an amount approximating $3.5 million annually for the performance of audits of health care providers in compliance with state and federal regulations, develops audit review criteria, and develops and controls monitoring activities of these contracts to ensure continued compliance. Interprets and applies Regulations of Title XIX of the Social Security Act and federal guidelines as they apply to programmatic and reimbursement issues.

5% Performs other duties as assigned to assist with the management and operations of the Rate Setting and Audit Section to meet the needs and priorities of the Bureau of Health Services Financing (BHSF) and the Department as necessary. Acts on behalf of the Rate Setting and Audit Section Chief in his/her absence or when delegated to do so.

Louisiana State Government represents a wide variety of career options and offers an outstanding opportunity tomake a differencethrough public service. With an array of career opportunities in every major metropolitan center and in many rural areas, state employment provides an outstanding option to begin or continue your career.

As a state employee, you will earn competitive pay, choose from a variety of benefits, and have access to a great professional development program:

Insurance Coverage More information can be found at https://info.groupbenefits.org/

Parental Leave– Up to six weeks paid parental leave

More information can be found athttps://www.civilservice.louisiana.gov/Parental-Leave/Default.aspx

Holidays and Leave – State employees receive the following paid holidays each year:

• New Year's Day

• Martin Luther King, Jr. Day,

• Mardi Gras,

• Good Friday,

• Memorial Day,

• Independence Day,

• Labor Day,

• Veteran's Day,

• Thanksgiving Day and Christmas Day.

* Additional holidays may be proclaimed by the Governor

State employees earn sick and annual leave which can be accumulated and saved for future use. Your accrual rate increases as your years of service increase.

Retirement – State of Louisiana employees are eligible to participate in various retirement systems (based on the type of appointment and agency for which an employee works). These retirement systems provide retirement allowances and other benefits for state officers and employees and their beneficiaries. State retirement systems may include (but are not limited to):

• Louisiana State Employees Retirement System (www.lasersonline.org). LASERS has provided this video (https://lasersonline.org/wp-content/uploads/2016/07/Your_Retirement_System.mp4) to give you more detailed information about their system

• Teacher's Retirement System of Louisiana (www.trsl.org),

• Louisiana School Employees Retirement System (www.lsers.net), among others

Agency

State of Louisiana

Address

For agency contact information, please refer to

the supplemental information above.

Louisiana State Civil Service, Louisiana, 70802

Phone

(866) 783-5462

Website

http://agency.governmentjobs.com/louisiana/default.cfm

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