Health Care Financing Program Manager ; NY HELPS

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.

Description
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.

• 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:
• Calculating, validating, approving, and implementing Medicaid fee-for-service rates for assigned provider groups.
• Reviewing programmatic and financial audit reports and ensuring appropriate findings are…