NY HELP Yes
Agency Health, Department of
Title Health Care Financing Program Manager 1 (NY HELPS) - 61604
Occupational Category Financial, Accounting, Auditing
Salary Grade 663
Bargaining Unit M/C - Managerial/Confidential (Unrepresented)
Salary Range From $115283 to $145682 Annually
Employment Type Full-Time
Appointment Type Permanent
Jurisdictional Class Competitive Class
Travel Percentage 0%
Workweek Mon-Fri
Hours Per Week 37.5
Workday
From 9 AM
To 5 PM
Flextime allowed? No
Mandatory overtime? No
Compressed workweek allowed? No
Telecommuting allowed? Yes
County Albany
Street Address Office of Health Insurance Programs / Division of Finance and Rate Setting / Bureau of Nursing Homes and Long Term Care Rate Setting
99 Washington Ave
City Albany
State NY
Zip Code 12210
Duties Description The Office of Health Insurance Programs (OHIP) is responsible for administering New York State's Medicaid program, which provides health coverage to millions of members and represents a significant portion of the State's annual health care expenditures.The Division of Finance and Rate Setting (DFRS) is responsible for OHIP functions related to Medicaid rate setting, including fee-for-service and managed care reimbursement. The Division oversees the Medicaid budget, serves as the primary liaison with the Division of the Budget, and supports management of the Medicaid Global Spending Cap.Within DFRS, the Bureau of Nursing Home and Long Term Care Rate Setting consists of four teams responsible for rate setting, cost analysis, reimbursement policy, and other financial evaluation activities affecting public and private nursing homes and a range of home and long-term care facilities, providers, and support services.The Health Care Finance Program Manager 1 will serve as an Assistant Bureau Director and provide managerial oversight of Medicaid fee-for-service rate setting and related financial operations for home care, hospice, foster care, and other assigned long-term care programs. The incumbent will lead multiple teams of professional financial and health care reimbursement staff and will be responsible for program administration, policy implementation, fiscal oversight, staff management, and coordination with internal and external stakeholders.The incumbent will:- Direct and oversee the development, review, approval, and implementation of annual, supplemental, and special Medicaid fee-for-service rate packages for assigned home care, hospice, foster care, and long-term care programs.- Oversee the collection, validation, reconciliation, and analysis of cost reports, provider financial submissions, utilization data, and other information used to establish and evaluate Medicaid reimbursement rates.- Direct the review and resolution of complex rate appeals, audit findings, payment disputes, litigation-related matters, and other reimbursement issues requiring managerial or policy-level review.- Evaluate the fiscal, operational, and provider impacts of proposed reimbursement methodologies, rate changes, budget initiatives, State and federal requirements, and programmatic reforms.- Coordinate and collaborate with rate-setting units, fiscal management staff, legal affairs, program offices, contractors, consultants, auditors, Medicaid providers, provider associations, other State agencies, and federal partners.- Represent the Bureau in meetings with OHIP executive staff, Department leadership, the Division of the Budget, the Executive Chamber, oversight entities, providers, and other stakeholders.- Direct the preparation of executive-level briefings, fiscal analyses, rate implementation updates, policy recommendations, decision memoranda, and presentation materials.- Establish, improve, and monitor policies, procedures, production schedules, internal controls, quality assurance standards, and documentation requirements governing assigned rate-setting programs.- Ensure reimbursement methodologies and operational procedures comply with applicable State and federal laws, regulations, Medicaid requirements, State Plan provisions, budget directives, and Department policies.- Directly supervise at least two G-27 team leads, including assigning work, establishing priorities, monitoring performance, evaluating staff, identifying training needs, managing workloads, and ensuring timely completion of assignments.- Provide managerial direction through subordinate supervisors for the completion of Bureau functions, including:o Calculating, validating, approving, and implementing Medicaid fee-for-service rates for assigned provider groups.o Reviewing programmatic and financial audit reports and ensuring appropriate findings are incorporated into rate-setting, provider payment, and contractor oversight processes.o Tracking, analyzing, and projecting Medicaid payment rates, expenditures, savings, and fiscal impacts on a quarterly and annual basis.o Maintaining organized and accessible rate files, financial analyses, program reports, policies, procedures, and supporting documentation for executive, audit, and legal review.o Drafting, reviewing, and implementing State Plan Amendments, State regulations, reimbursement methodology documents, provider guidance, and related fiscal impact analyses.o Researching, interpreting, and applying relevant State and federal laws, regulations, policies, reimbursement requirements, and executive directives.o Monitor program performance, staffing capacity, production deadlines, contractor deliverables, and emerging fiscal or operational risks, and recommend corrective actions or resource adjustments to the Bureau Director.o Advise the Bureau Director and DFRS leadership regarding rate-setting priorities, policy issues, staffing needs, fiscal impacts, provider concerns, and recommended program or organizational changes.
Minimum Qualifications Permanent Transfer Candidates: Current New York State Department of Health employee with permanent or contingent permanent status as a Health Care Financing Program Manager 1, OR; Current New York State employee with one year or more of permanent or contingent permanent, competitive service in a title eligible to transfer under to a Health Care Financing Program Manager 1 under Section 52.6 of the Civil Service Law.Non-Competitive Candidates via NY HELPS Program:A bachelor's degree and four years professional* experience in finance. One year of this experience must be in the management and supervision of health care financing, including any of the following: health care facility reimbursement, managed care capitation models, health care fiscal analysis, or health care fiscal policy development. This one year must include making policy recommendations regarding health care financing mechanisms and must include the oversight of staff who have supervisory responsibilities for professional staff. Clerical or secretarial experience will not be considered qualifying.Substitution: a Juris Doctor, master's or higher degree in a related field can substitute for one year of specialized experience.Preferred Qualifications: Strong critical thinking skills, strong analytical skills, significant experience with Microsoft Excel, ability to solve problems independently. Professional work experience should include knowledge of Medicaid policy, rate setting, and trend analysis. The candidate should have knowledge of the NYS Medicaid program and have the ability to interact and collaborate with other Medicaid-related State Agencies, as well as the Division of the Budget and Centers for Medicare & Medicaid Services.
Additional Comments Microsoft Excel knowledge, skills, and abilities are a requirement.When reviewing qualifications, omissions and vagueness cannot be interpreted in the candidate's favor. Candidates are responsible for providing accurate and clear descriptions of their experience demonstrating how they meet the minimum qualifications. This position is part of the NYS HELPS program. No examination is required. We offer a work-life balance and a generous benefits package, worth 65% of salary, including:- Holiday & Paid Time Off- Public Service Loan Forgiveness (PSLF)- Pension from New York State Employees' Retirement System - Shift & Geographic pay differentials - Affordable Health Care options- Family dental and vision benefits at no additional cost - NYS Deferred Compensation plan- Access to NY 529 and NY ABLE College Savings Programs, and U.S. Savings Bonds- And many more...The NYS Department of Health is committed to making New York a safer, healthier, and more equitable place to live. Understanding health equity, social determinants of health and health disparities is critical to accomplish our goal of eliminating health disparities. For more information on the NYS Department of Health's Mission, Vision, Values and Strategic Plan, please visit: https://health.ny.gov/commissioner/index.htmIf you require reasonable accommodation to complete a job application, a job interview or to otherwise participate in the hiring process, please contact by phone 518-486-1812 or email doh.sm.Reasonable.Accommodation@health.ny.gov to make a request.The NYS Department of Health does not participate in E-Verify and does not sponsor visa applications.For new State employees appointed to graded positions, the annual salary is the hiring rate of the position (beginning of the salary range). Promotion salaries are calculated by the NYS Office of the State Comptroller in accordance with NYS Civil Service Law, OSC Payroll rules and regulations, and negotiated union contracts.
Some positions may require additional credentials or a background check to verify your identity.
Name Human Resources Management Group, CD/HCFPM1/61604
Telephone 518-486-1812
Fax 518-473-3395
Email Address Resume@health.ny.gov
Address
Street Corning Tower, Empire State Plaza, Room 2217
City Albany
State NY
Zip Code 12237
Notes on Applying Please submit your resume and cover letter as one (1) document, preferably in PDF format, by email to resume@health.ny.gov, with Reference CD/HCFPM1/61604 included in the subject line or by mail to Human Resources Management Group, CD/HCFPM1/61604, Rm 2217, Corning Tower Building, Empire State Plaza, Albany, NY 12237-0012, or by fax to (518) 473-3395. Failure to include the required information may result in your resume not being considered for this position.
