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DIRECTOR, OFFICE OF MEDICAID PROVIDER SERVICES

PROGRAM MANAGER SENIOR III

Recruitment #23-005484-0023

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Introduction

GRADE

25

LOCATION OF POSITION

MDH, Office of Medicaid Provider Services, Baltimore, MD

Main Purpose of Job

This position is responsible for directing several agency-unique programs that have a broad scope and major impact on the Medicaid Agency's missions and operations. The primary purpose of the Director of the Office Medicaid Provider Services (OMPS) is to direct the Medicaid Program’s relationship with over 105,000 providers. The role also facilitates high priority and strategic procurements to improve the operations of the office of provider services. This position directly supervises 129 professional and administrative staff, and indirectly supervises technical Project Management Office staff. This position receives managerial supervision directly from the Medicaid Director; an Executive Service employee.

This position plans, directs and administers all aspects of the following Medicaid agency programs: 

  1. Care Management Integration Program – LTSS
    1. LTSS Software Development 
    2. LTSS Operations 
    3. LTSS Project Management Office (PMO) 
    4. LTSS Technical Support 
    5. In-home Supports Assurance System (ISAS) Program 
  2. Provider Enrollment Program 
    1. Provider Enrollment Contract Implementation and Monitoring 
    2. Provider Enrollment Administrative Services 
    3. Moderate Risk Provider Site Visits 
  3. Provider Policy, Compliance & Clinical Quality Improvement Program 
    1. Provider Policy Development & Implementation (includes State regulations, Federal State Plan, sub-regulatory transmittals and billing manuals) 
    2. Provider Compliance Program, including Excluded Provider Tracking and Monitoring, as well as Federal Audit Oversight 
    3. Federal Interoperability Program 
    4. Provider Exclusions 
    5. Hospital & Family Planning Presumptive Eligibility Program 
    6. Telehealth Program
    7. Other related health information exchange projects 
  4. Professional Provider Relations Program 
    1. Professional Services Call Center 
    2. Professional Services Claims Resolution 
  5. Institutional Provider Relations Program 
    1. Institutional Services Call Center 
    2. Institutional Services Claims Resolution 
  6. Long Term Care Provider Resolution Unit 
  7. Division of Claims Services 
    1. Claims Processing
    2. Adjustments 
    3. Claims Mailroom/batching 
    4. MCO Capitation 
As needed, the Medicaid Director may request this position be readily available for high priority projects, which include coordinating and implementing cross cutting projects (projects that require the planning and coordination with the Chief Portfolio Officer, MDThink, Office of Enterprise Technology(OET),The Office of Medicaid Finance(OOF), the Office of Eligibility Services(OES), the Office of Medical Benefits Management(OMBM), the Office of Pharmacy Services(OPS), the Office of Long Term Services & Supports(OLTSS), and the Office of Innovation, Research & Development(IRD) as well as sister agencies.

MINIMUM QUALIFICATIONS

Qualified candidates must possess a Bachelor's degree from an accredited college or university and 6 years of professional level health services experience, 3 of which must have involved working with medicaid provider services and 3 years of which must have been at a management or supervisory level.

A Master's degree will substitute for one year of the general experience and a Doctorate degree will substitute for two years of the general experience. Additional experience will substitute on a year-for-year basis for the Bachelor's degree.

DESIRED OR PREFERRED QUALIFICATIONS

Preferred candidates should possess the following:

  • Experience accurately applying or interpreting and analyzing Medicaid regulations, policies, and procedures.
  • Experience establishing and implementing procedures for Federal entitlement programs. 
  • Experience monitoring program compliance.
  • Experience managing resources and workflows to ensure operational goals are met successfully. 
  • Experience analyzing program data for reporting and presentation to management. 
  • Experience assisting customers and participating in meetings with representatives from a diverse background with resolving concerns.
  • Experience in claims and revenue cycle processes and procedures.
  • Experience in Long Term Care helpful.
  • Knowledge and experience using multiple data systems. 
  • Project management experience and be able to demonstrate an ability to complete tasks timely and accurately.  

SELECTION PROCESS

This is a Management Service position, and serves at the pleasure of the Appointing Authority.  A resume must accompany your application.

Applicants who meet the minimum (and selective) qualifications will be included in further evaluation. The evaluation may be a rating of your application based on your education, training and experience as they relate to the requirements of the position. Therefore, it is essential that you provide complete and accurate information on your application. Please report all related education, experience, dates and hours of work. Clearly indicate your college degree and major on your application, if applicable. For education obtained outside the U.S., any job offer will be contingent on the candidate providing an evaluation for equivalency by a foreign credential evaluation service prior to starting employment (and may be requested prior to interview). 

Complete applications must be submitted by the closing date. Information submitted after this date will not be added. 

Incorrect application forms will not be accepted.

Candidates may remain on the certified eligible list for a period of at least one year. The resulting certified eligible list for this recruitment may be used for similar positions in this or other State agencies.

BENEFITS

The Maryland Department of Health offers the following benefits:

  • Meaningful Work 
  • Excellent Health Benefits Package, including Medical, Vision, Prescription and Dental 
  • Flexible Spending Accounts (Reduced Child and Health Care) 
  • Generous Leave Benefits (6 Personal Days, 12 Regular Holidays, Annual Leave, 15 Sick Days) 
  • Retirement Paid 
  • Parental Leave 
  • Flexible Work Schedules (where applicable) 
  • Free Mass Transit (Baltimore metro area) 
For a full list of the benefits of working for the State of Maryland, please click the link below:

STATE OF MARYLAND BENEFITS

 

FURTHER INSTRUCTIONS

Online applications are highly recommended. However, if you are unable to apply online, the paper application (and supplemental questionnaire) may be submitted to MDH, Recruitment and Selection Division, 201 W. Preston St., Room 114-B, Baltimore, MD 21201. Paper application materials must be received by 5 pm, close of business, on the closing date for the recruitment, no postmarks will be accepted.

If additional information is required, the preferred method is to upload.  If you are unable to upload, please fax the requested information to 410-333-5689. Only additional materials that are required will be accepted for this recruitment. All additional information must be received by the closing date and time.

For questions regarding this recruitment, please contact the MDH Recruitment and Selection Division at 410-767-1251.

If you are having difficulty with your user account or have general questions about the online application system, please contact the MD Department of Budget and Management, Recruitment and Examination Division at 410-767-4850 or Application.Help@maryland.gov. 

Appropriate accommodations for individuals with disabilities are available upon request by calling: 410-767-1251 or MD TTY Relay Service 1-800-735-2258.

We thank our Veterans for their service to our country.

People with disabilities and bilingual candidates are encouraged to apply.

As an equal opportunity employer, Maryland is committed to recruitment, retaining and promoting employees who are reflective of the State's diversity.




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