State of Connecticut Executive Branch

In the Department of Mental Health and Addiction Services this class is accountable for directing the determination of reimbursement rates for contracts negotiated by the department for the provision of behavioral health services or coordination of all revenue reimbursement efforts.

Receives administrative direction from the Chief of Fiscal/Administrative Services or other administrative official of higher grade.

• Directs staff and operations of a healthcare finance or billing unit;
• Coordinates, plans and manages unit activities including contact with insurance and managed care providers regarding billing and revenue data, Medicare Cost report information and related data to ensure obtaining maximum revenue and/or reimbursement;
• Formulates program goals and objectives;
• Develops or assists in development of related policy and procedures;
• Initiates, interprets and administers pertinent laws;
• Evaluates staff;
• Maintains contacts with individuals within and outside of unit who might impact program activities;
• Manages development of new program initiatives involving financial and cost analysis, rate setting, billing and cost containment or recovery;
• Assists in planning and implementation of financial and billing aspects of managed care programs;
• Prepares and analyzes complex financial statements, reports and budget requests;
• Prepares revenue projections including expenditures 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;
• Provides training and education to managed care providers to ensure meeting billing requirements;
• Ensures managed care provider compliance allowing for federal reimbursement for services rendered;
• Analyzes and interprets federal and state laws and regulations relevant to rate setting and revenue and/or reimbursement;
• Conducts data analysis of claims payments, analysis of services billed and/or not billed and payments made and/or not made;
• Coordinates re-billing with Department of Administrative Services;
• Oversees setup of service codes, insurances, diagnosis code updates and other billing related tables;
• Leads the recruitment and hiring of staff, including outreach, interview and selection;
• 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.

• Considerable knowledge of
  • and ability to apply management principles and practices;
  • relevant state and federal laws, statutes and regulations;
  • principles of health care administration, financial management and billing administration;
  • health care budgeting principles;
  • principles of cost analysis;
• Considerable
  • interpersonal skills;
  • oral and written communication skills;
• Considerable ability to prepare and interpret financial and statistical reports.

One (1) year of the General Experience must have been in a supervisory capacity over professional staff involved in health care cost analysis.

NOTE: For state employees this experience is interpreted at the level of a Fiscal Administrative Supervisor performing health care cost analysis or Principal Health Care Analyst.

• College training may be substituted for the General Experience on the basis of fifteen (15) semester hours equalling one-half (1/2) year of experience to a maximum of four (4) years for a Bachelor's degree.
• A Master’s degree in a closely related field may be substituted for one (1) additional year of the General Experience.
• A law degree may be substituted for one (1) additional year of the General Experience.