|Job Description :
Section Manager – Clinic Finance, Premium Payments & COFA Programs (WMS3/FSD)
Per Governor Inslee’s Proclamation 21-14 state employees must be fully vaccinated. Your vaccine status will be verified on your first day of work. Please note, medical or religious accommodation may be available, once an offer of employment is made.
About the Division:
This position is located within HCA’s Financial Services Division (FSD), which in collaboration with other HCA divisions and a variety of external stakeholders and legislative partners, provides strategic financial expertise for the Medical Assistance (MA), Community Behavioral Health (CBH), PEBB and SEBB programs. In addition, FSD oversees the budget and compliance functions necessary to manage and monitor a $12 billion annual budget.
About the position:
The Section Manager of Clinical Finance, Premium Payments and COFA’s primary responsibility is to lead the strategic fiscal functions that support the development and oversight of the program. This position is responsible for overseeing the rate setting/payment methodology, policy and procedures development and implementation of numerous programs.
The incumbent will be responsible for managing the coordination and development of financial analyses necessary to understand and explain revenue trends and changes, for fiscal notes and for modeling changes in program or policy. This position provides the direction for the process of updating the forecast to reflect the policy and rate changes to the program. This position coordinates with program staff in multiple agencies as well as community and provider stakeholders. This role ensures that excellent customer service is provided and timely completion of projects and other deliverables to meet customer expectations.
The Clinic Finance, Premium Payment & COFA Programs Section Manager supervises 12 FTEs.
This position is eligible to telework part time but is frequently required to report on-site to meet business need.
Some of what you will do:
Oversee the work performed by the Clinic Finance unit for Federally Qualified Health Centers(FQHC) and Rural Health Clinics (RHC) policy and reimbursement.
The FQHC/RHC Payments unit is responsible for the development, implementation and maintenance of rate methodologies, rate setting and rate adjustment processes, payments and settlements administered through managed care plans for FQHC and RHC programs.
Oversee the activities of the Premium Payment Program unit (PPP).
The Premium Payment Program unit administers the payment of private insurance premiums and cost sharing for clients who are dually enrolled in Medicaid and employer-sponsored commercial plans.
Oversee the monthly payment functions to the Health Plans/carriers and contracted entities for the payment of premiums and out of pocket expenses for eligible COFA citizens.
The COFA islander’s premium payment program was created as a result of the enactment of the Substitute Senate Bill 5683. COFA islanders include people from the Republic of the Marshall Islands, the Federated State of Micronesia, and the Republic of Palau.
Set strategic goals and direction for the section that align the processes and outcomes of the section to the agency’s mission and values.
Determine collaborative strategic planning for the section, including continuous quality improvement to processes, designing and implementing new systems and business practices and managing change.
Coordinating, communicating, planning, and managing all activities related to the programs under its oversight.
Representing HCA as a subject matter expert in these matters to internal and external stakeholders and to the HCA’s authorizing environment such as the Legislature, OFM and CMS.
Providing strong leadership to and supervision of section employees.
Developing, maintaining and monitoring of federal and state processes, policies and procedures for assigned programs, to ensure fiscal accountability and to minimize the HCA’s exposure to financial and legal risk.
Bachelor’s Degree in business or public administration, finance, accounting, mathematics, statistics, or other related field.
Three (3) years of successful experience with budget development, strategic planning, contract development and management.
Two (2) years of successfully managing staff, within an environment that is friendly to alternative work schedules and teleworking arrangements.
A Master’s degree in finance, public administration or related field.
Practical, hands-on knowledge/experience of the Washington State legislative process.
Project Management experience/certification.
[CM(1] Familiarity with pay-for-performance and bundled payment concepts.
Familiarity with outpatient hospital and inpatient billing and coding.
Ability to interpret SQL coding and suggest coding changes as needed for correct data extraction.
Experience with selective contracting and Request for Proposal procedures.
Advanced knowledge of ProviderOne.
Knowledge of Medicaid benefit packages.
Expert knowledge of the Collective Bargaining Agreement.
Knowledge of provisions of the Affordable Care Act and healthcare reform.
Knowledge of all-inclusive rate methodologies (i.e., encounters in FQHCs/RHCs).
Knowledge of federal Medicaid and Medicare statutes (USC), codes (CFR), state laws (RCW), regulations(WAC), and Medicaid state plan (SPA) pertaining to reimbursement.
Knowledge of managed care policy and payment mechanisms.
Advanced knowledge of general medical billing and coding guidelines.
How to Apply:
Only candidates who reflect the minimum qualifications on their NEOGOV profile will be considered. Failure to follow the application instructions below may lead to disqualification. To apply for this position, you will need to complete your profile and attach:
A cover letter that specifically addresses how you meet the qualifications for this position.
Three professional references, including a minimum of one past supervisor
The Washington State Health Care Authority (HCA) is committed to whole-person care, integrating physical health and behavioral health services for better results and healthier residents.
HCA purchases health care for more than 2.5 million Washington residents through Apple Health (Medicaid), the Public Employees Benefits Board (PEBB) Program, and the School Employees Benefits Board (SEBB) Program. As the largest health care purchaser in the state, we lead the effort to transform health care, helping ensure Washington residents have access to better health and better care at a lower cost.
What we have to offer:
Meaningful work with friendly co-workers who care about those we serve Voices of HCA
A clear agency mission that drives our work and is person-centered HCA’s Mission, Vision & Values
A healthy work/life balance, including alternative/flexible schedules and mobile work options.
Infants in the workplace Infants at the Workplace Video
A great total compensation and benefit package WA State Government Benefits
A safe, pleasant workplace in a convenient location with restaurants, and shopping nearby.
And free parking!
The Washington State Health Care Authority is an equal opportunity employer. We strive to create a working environment that provides equal access and opportunity to anyone who qualifies, regardless of sex, race, age, color, religion, mental or physical disability, national origin, sexual orientation, gender identity and expression and/or military status. Persons with disabilities needing assistance in the application process, or those needing this job announcement in an alternative format may call the Human Resources Office at 360.725.1723 or email email@example.com
Prior to a new hire, a background check including criminal record history will be conducted. Information from the background check will not necessarily preclude employment.