CS-214 Position Description Form
|CS-214 | | 1. Position Code |
|REV 8/2007 | | |
| |State of Michigan | |
| |Civil Service Commission | |
| |Capitol Commons Center, P.O. Box 30002 | |
| |Lansing, MI 48909 | |
|Federal privacy laws and/or state confidentiality |POSITION DESCRIPTION | |
|requirements protect a portion of this information. | | |
|This form is to be completed by the person that occupies the position being described and reviewed by the supervisor and appointing authority to ensure its |
|accuracy. It is important that each of the parties sign and date the form. If the position is vacant, the supervisor and appointing authority should complete|
|the form. |
|This form will serve as the official classification document of record for this position. Please take the time to complete this form as accurately as you can |
|since the information in this form is used to determine the proper classification of the position. THE SUPERVISOR AND/OR APPOINTING AUTHORITY SHOULD COMPLETE |
|THIS PAGE. |
| 2. Employee’s Name (Last, First, M.I.) | 8. Department/Agency |
| |Michigan Department of Health and Human Services |
| 3. Employee Identification Number | 9. Bureau (Institution, Board, or Commission) |
| |Bureau of Audit |
| 4. Civil Service Classification of Position | 10. Division |
|State Administrative Manager 15 |Hospital & Clinic Reimbursement Division |
| 5. Working Title of Position (What the agency titles the position) | 11. Section |
|Section Manager 15 |Hospital Settlement Section |
| 6. Name and Classification of Direct Supervisor | 12. Unit |
|Craig Castagnasso, State Division Administrator 17 | |
| 7. Name and Classification of Next Higher Level Supervisor | 13. Work Location (City and Address)/Hours of Work |
|Pam Myers, Senior Management Executive 19 |Lansing, 320 S. Walnut / 8 a.m. – 5 p.m., M-F |
| 14. General Summary of Function/Purpose of Position |
| |
|This position functions as the State Administrative Manager for the Hospital & Clinic Reimbursement Division. This position assists in the overall planning |
|and directing of hospital cost reporting and segments of reimbursement for Title XIX, Title V, Adult Waiver Benefits-ABW, Maternity Outpatient Medical |
|Services-MOMS, Healthy Michigan Plan-HMP etc., for the Department of Health and Human Services. Working within general policies and procedures, the employee |
|in this position exercises considerable independent judgment in assisting in the development and implementation of new approaches to the departmental |
|administration of hospital reimbursement under the supervision of a State Division Administrator 17. This position assists in the planning and directing of |
|specific departmental activities relating to the hospital cost report acceptance process and reviews and evaluates the work of program personnel to ensure |
|conformance with general guidelines, methods, techniques, policies, and laws associated with hospital reimbursement in conjunction with divisional management |
|staff. Supervisory functions include approving employee sick and annual leave usage, conducting performance reviews, counseling employees, suspending and/or |
|dismissing employees, participating in employee grievance procedures, and the hiring and training of personnel. |
|For Civil Service Use Only |
| 15. Please describe your assigned duties, percent of time spent performing each duty, and explain what is done to complete each duty. |
|List your duties in the order of importance, from most important to least important. The total percentage of all duties performed must equal 100 percent. |
|Duty 1 |
|General Summary of Duty 1 % of Time 40 |
| |
|Plans, organizes, directs, and controls the work activities of the Hospital Settlement Section in the Hospital & Clinic Reimbursement Division. As an |
|assistant division administrator, this position has the responsibility for assisting in the overall direction of hospital settlement and payment processing. |
|Individual tasks related to the duty. |
|Works with division, bureau, administration, and department staff, provider groups, state contractors, and staff from other departments to develop and |
|implement new audit and reimbursement methods for hospitals for Title XIX and Title V, Adult Benefit Waiver-ABW, Maternity Outpatient Medical Services-MOMs, |
|Healthy Michigan Plan-HMP etc. Errors in application of policies or procedures can result in misspent funds, legal problems for future appeals and loss of |
|revenue due to federal disallowance. The high dollar impact of decisions on the state budget and the providers’ financial stability results in a high degree |
|of sensitivity and scrutiny. The policy development for the division sets direction for future audits, ongoing program policy, and future reimbursement and |
|funding stability. |
|In the absence of the Division Director, this position may serve as Acting Division Director with the authority to make decisions affecting the Hospital & |
|Clinic Reimbursement Division. |
|Coordinate work by scheduling assignments and directing the work of subordinates. |
|The hospital reimbursement program involves cost report filing and acceptance, interim payments, settlements, audits, and appeals. There are over 150 hospital|
|sites statewide. These hospitals file cost reports annually and the efficiency and accuracy of these reports impact all special payments. Total Medicaid |
|payments to these providers are in excess of $1.5 billion annually. |
|Coordinates and ensures that site visits are performed by audit staff. |
|Provides final approval to the calculation and review of hospital settlements, audit reviews and findings, approving payments, and notifying providers. |
|Oversees the following auditor duties: |
|Review of Facility Settlement (FS) validation errors/comments for hospitals. |
|Delinquent letters to providers whose Michigan Medicaid Cost Report & Centers for Medicare & Medicaid Services-CMS 2552 are not filed timely. |
|Review Acceptability Checklist including oversight of comparison worksheets and tracing data from Medicaid Cost Report to CMS 2552. |
|Review cost report extension and amendment requests. |
|Duty 2 |
|General Summary of Duty 2 % of Time 20 |
| |
|Work with policy staff and management to formulate current and long-range programs, plans, and policies for hospital cost reporting and reimbursement |
|activities. |
|Individual tasks related to the duty. |
|Directs the revision and analyzes the impact of rules, regulations and state and federal legislation affecting the division’s areas of responsibility and |
|prepares position statements relating to such. |
|Bring up problems and conflicts with current policy. Recommend various options and solutions. |
|Discuss and recommend new policy and determine the impact on current operations and cost. |
|Assist Policy Division in drafting responses to CMS regarding audits and financial reviews. |
|Represent the department in appeal proceedings. |
|Coordinate activities, receive feedback, identify problems, and recommend solutions. Bring to director’s attention policies and procedures that require |
|correction and modification. |
|Duty 3 |
|General Summary of Duty 3 % of Time 20 |
| |
|Confers with officials of federal, state, and local agencies, legislators, governor’s aides, professional organizations, and interest groups on matters |
|relating to hospital reimbursement. |
|Individual tasks related to the duty. |
|Works with other department officials (Department of Technology, Management, and Budget-DTMB, Department of Licensing and Regulatory Affairs-LARA, Department |
|of Treasury, Attorney General, House and Senate Fiscal Agencies) as well as outside professional and provider organization officials on matters relating to |
|hospital audit and reimbursement. |
|Coordinates with the Medicare Intermediaries on common audit and reimbursement issues. |
|Works with outside contractors that have contracts with the Medicaid program and Hospital & Clinic Reimbursement Division relating to hospital filed cost |
|reports and hospital settlements. |
|Represents the division at conferences, seminars, hospital workgroups, and other forums that involve hospital reimbursement. |
|Duty 4 |
|General Summary of Duty 4 % of Time 10 |
| |
|Evaluates and approves payments to over 150 hospitals through the Medicaid Interim Payment (MIP) and Capital Interim Payment (CIP) programs. Review accuracy of|
|and approve upper payment limit (UPL) recoveries at cost acceptance and payments/recoveries final cost settlements. |
| |
|As the manager in charge of and having the final authority for the MIP, CIP, UPL, and final settlement processes this position requires a comprehensive |
|knowledge of hospital cost reporting and Medicaid reimbursement for several programs involving different methods of reimbursement, such as Title XIX Med/Surg |
|and Rehab, Title V Med/Surg and Rehab, MOMS, ABW, HMP, and Healthy Kids. The methods of reimbursement include special financing pool payments, DRG, Per Diem, |
|Prospective Capital Rate, Cost-to-Charge ratio, and/or per case add-on. |
|Individual tasks related to the duty. |
|Develop, implement, and maintain the MIP and CIP reimbursement system for all hospitals in the state. |
|This position oversees designs standardized reimbursement templates, letters for use in the database support system to promote appropriate and accurate |
|reimbursement to hospitals. |
|Coordinate, monitor, and review the utilization, case mix, and rates that go into the calculation of the MIP and CIP, and approving MIP reconciliations |
|payments. |
|Establishes budgets and coordinates these estimates with the MDCH Budget Office and the State DMB Budget Office on a regular basis, due to the significance of |
|the dollars and programs involved. |
| |
|This area is highly complex and has significant impact on the MDCH and the State of Michigan budget. It has the significance of being the one area that holds |
|the State of Michigan’s books open for year-end closing. This area is audited annually by the Office of Auditor General as well as the federal government, due|
|to the significant dollars involved. |
|Duty 5 |
|General Summary of Duty 5 % of Time 10 |
| |
|Perform personnel and other duties as follows. |
|Individual tasks related to the duty. |
|Oversee the annual accrual calculation for capital. |
|Assume the duties of the division director and other state administrative managers when they are on leave or not available. |
|Maintain records, prepare reports, and conduct correspondence relative to the work. |
|Perform other related work as assigned. |
|Select and assign staff, ensuring equal employment opportunity in hiring and promotions, identify staff development needs and ensure that training is obtained,|
|and ensure that proper labor relations and conditions of employment are maintained. |
|Hiring staff and conducting performance reviews. |
|Suspending or dismissing staff and participating in employee grievance procedures. |
|Approve leave and time reports for staff. |
|Recommend and encourage staff to attend computer, accounting, auditing, billing and other training classes and seminars. |
|Duty 6 |
|General Summary of Duty 6 % of Time |
| |
|Individual tasks related to the duty. |
| 16. Describe the types of decisions you make independently in your position and tell who and/or what is affected by those decisions. Use additional sheets, |
|if necessary. |
|Independent decisions are made when rules, regulations, or policies are unclear or nonexistent. Samples of independent decisions include: documentation and |
|testimony presented at appeal hearings, comparisons of proposed rule changes and impact on current operations, assignment of projects to various staff based on|
|project requirements and individual staff expertise. |
| 17. Describe the types of decisions that require your supervisor’s review. |
|When the decision is highly political in nature and/or federal funding is questionable. |
| 18. What kind of physical effort do you use in your position? What environmental conditions are you physically exposed to in your position? Indicate the |
|amount of time and intensity of each activity and condition. Refer to instructions on page 2. |
|Most work is done in an office setting. Periodic travel is necessary for meetings with industry work groups, to attend seminars and to conduct presentations. |
| 19. List the names and classification titles of classified employees whom you immediately supervise or oversee on a full-time, on-going basis. (If more than |
|10, list only classification titles and the number of employees in each classification.) |
|NAME |CLASS TITLE |NAME |CLASS TITLE |
|5 (4 existing, 1 vacant) |Auditor E |2 (existing) |Auditor A |
|Michael Gonzales |Auditor Specialist | | |
| | | | |
| | | | |
| | | | |
| 20. My responsibility for the above-listed employees includes the following (check as many as apply): |
|X Complete and sign service ratings. X Assign work. |
|X Provide formal written counseling. X Approve work. |
|X Approve leave requests. X Review work. |
|X Approve time and attendance. X Provide guidance on work methods. |
|X Orally reprimand. X Train employees in the work. |
| 21. I certify that the above answers are my own and are accurate and complete. |
| |
|Signature Date |
NOTE: Make a copy of this form for your records.
|TO BE COMPLETED BY DIRECT SUPERVISOR |
|22. Do you agree with the responses from the employee for Items 1 through 20? If not, which items do you disagree with and why? |
| |
|Yes. |
| 23. What are the essential duties of this position? |
| |
|The duty of this position is to manage the reimbursement and financial reporting of hospitals. This involves supervising the staff, policy review, resource |
|management, reporting and budgeting. |
| 24. Indicate specifically how the position’s duties and responsibilities have changed since the position was last reviewed. |
|New position. |
| 25. What is the function of the work area and how does this position fit into that function? |
| |
|The Hospital & Clinic Reimbursement Division provides for the Title XIX and Title V, ABW, MOMs, HMP etc., rate reimbursement and cost settlement for hospitals,|
|rural health clinics, federally qualified health centers, tribal health centers, qualified health plans, school-based services, local public health department,|
|MIChoice Agencies, and state psychiatric hospitals. The division is responsible for the formation of policy and operational control of a variety of |
|reimbursement methodologies for the department. |
| |
|This position has the responsibility of managing the Section’s professional auditors and support staff, and to ensure that hospital financial reporting and |
|settlements are accurate. |
| 26. In your opinion, what are the minimum education and experience qualifications needed to perform the essential functions of this position. |
|EDUCATION: |
|Bachelor’s Degree in any major. Twenty-four semester or 36 term credits in Accounting desirable. |
|EXPERIENCE: |
|Four years of professional experience, including two years equivalent to the experienced (P11) level or one year equivalent to the advanced (12) level. |
| |
|Alternate E&E for a SAM 15: Education level typically acquired through completion of high school and two years of safety and regulatory or law enforcement |
|experience at the 14 level; or, one year of safety and regulatory or law enforcement experience at the 15 level, may be substituted for the education and |
|experience requirements. |
|KNOWLEDGE, SKILLS, AND ABILITIES: |
|Extensive knowledge of: 1) rules and regulations related to various health care payers (Medicaid, Medicare, and commercial) 2) health care reimbursement and |
|institutional claims. Communications skills that allow reporting and presentations of information to upper management, industry groups and associations, |
|staff, and other managers within and outside the department. Ability to manage various projects to meet required time frames. |
|CERTIFICATES, LICENSES, REGISTRATIONS: |
|None. |
|NOTE: Civil Service approval of this position does not constitute agreement with or acceptance of the desirable qualifications for this position. |
| 27. I certify that the information presented in this position description provides a complete and accurate depiction of the duties and responsibilities |
|assigned to this position. |
| |
|Supervisor’s Signature Date |
|TO BE FILLED OUT BY APPOINTING AUTHORITY |
| 28. Indicate any exceptions or additions to the statements of the employee(s) or supervisor. |
| 29. I certify that the entries on these pages are accurate and complete. |
| |
|Appointing Authority’s Signature Date |
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