State of Michigan
Civil Service Commission
Position Code
1. DEPSPL2I50N
Capitol Commons Center, P.O. Box 30002
Lansing, MI 48909
POSITION DESCRIPTION
This position description serves as the official classification document of record for this position. Please complete the
information as accurately as you can as the position description is used to determine the proper classification of the position.
2. Employee's Name (Last, First, M.I.)
8. Department/Agency
DHHS-MSA-COM HEALTH CENTRAL OFFICE
3. Employee Identification Number
9. Bureau (Institution, Board, or Commission)
Bureau of Medicaid Operations & Actuarial Services
4. Civil Service Position Code Description
10. Division
DEPARTMENTAL SPECIALIST-2
Actuarial Division
5. Working Title (What the agency calls the position)
11. Section
Departmental Specialist 2
Rates & Encounter Data Section
6. Name and Position Code Description of Direct Supervisor
12. Unit
DUPUIS, JULIE F; STATE ADMINISTRATIVE MANAGER-1
15
n/a
7. Name and Position Code Description of Second Level Supervisor
13. Work Location (City and Address)/Hours of Work
RUTLEDGE, PENNY; STATE DIVISION ADMINISTRATOR
17
400 S PINE ST; CAPITOL COMMONS BLDG LANSING, MI
48933 / 08:30 am-5:00 pm Monday through Friday
14. General Summary of Function/Purpose of Position
This position specializes in carrying out the Department's mission while following Statewide initiatives that expand health
care service access to Medicaid enrollees. This position is very complex in nature involving numerous variables
surrounding the operations and is responsible for: The Public Entity Physician Supplemental Payment Program, the
Specialty Network Access Fee program, and the Dental Adjustment Payment Program increasing the revenue in Michigan
by $400 million annually. The individual in this position must be a subject matter expert in the area of Medicaid special
financing and intergovernmental transfer mechanisms and must have the ability to respond in writing as well as orally to
complex inquiries from senior agency management, all of the participating Michigan Units of government (public entities),
health care providers, professional associations and other interested parties. These initiatives contain large amounts of
variables that utilize a full range of advanced software technology and medical specialty services available through the
State’s university based medical education and physician practice groups and advanced specialty groups. Supplemental
payment distributions are made to over 9,500 participating physicians located throughout the State. Supplemental
payments are processed for both the fee-for-service and managed care payer systems. Because of the involvement in
these groups and with the overall understanding of Medicaid payment the position acquired substantial additional duties
related to the Affordable Care Act including full project management for section 1202 of the ACA – primary care incentive
payments to Managed Care Entities and Providers. This new duty is built upon the knowledge of the supplemental payment
processes tracking enrolled providers and then excluding those physicians from the ACA-Primary care incentives
payments. Intricate knowledge of the provider community and payment processes as well as delicate communications to
providers, managed care organizations and upper management, as this process is unique to State government.
15. Please describe the assigned duties, percent of time spent performing each duty, and what is done to complete each duty.
List the duties from most important to least important. The total percentage of all duties performed must equal 100 percent.
Duty 1
General Summary:
Percentage:
50
Manage and execute all actuarial and operational tasks of the Public Entity Physician Supplemental Payment Program.
Continuing development of policies, procedures and financial controls to improve efficiency of program operation and
enhancement of reimbursement to providers.
Individual tasks related to the duty:
•
•
•
•
•
•
•
•
•
•
•
•
•
•
Write new policies, revise existing policies to clarify and/or expand on operational control procedures, methods for payment computation and terms of
provider participation.
Research federal and state regulations pertaining to Intergovernmental Transfers under Medicaid statutes.
Responsible for maintaining current knowledge of and acting as subject-matter expert for Medicaid Special Financing regulations and for advising senior
management in this area.
Write and execute queries (Bi-Query) to extract individual provider claims information from the Michigan Medicaid Data Warehouse.
Maintain advanced professional computing and data analysis skills with multiple software packages including “bi-query” Hummingbird packages,
Microsoft Office software, SPSS and maintain general working knowledge of Computer hardware and MMIS systems as necessary to competently
produce needed analytical products.
Calculate the quarterly distribution of provider supplemental payments for the fee-for-service and managed care payer systems.
Utilize database and spreadsheet products to organize claims data and to facilitate analytical examination of this information.
Use skills in formal logic and reasoning, mathematics and statistics to design analytical products to support the overall system design and the various
reporting requirements of the program.
Use skills in writing and basic composition for communicating complex and technical information to senior management and to internal and external
parties.
Correspond with Public Entities on supplemental payment distributions and all other required financial transactions.
Prepare all required documentation to process payment, distribution and refunding transactions.
Develop procedures to promote the financial integrity of system operations and technical compliance with generally accepted actuarial methods and
procedures.
Respond to and manage all program audits.
Use skills in formal logic and reasoning to produce objective, evidence-supported analytical products demonstrating impact of these state-wide programs
on Michigan’s Medical safety-net system.
Duty 2
General Summary:
Percentage:
25
Conducts all analysis and maintains all operational functions to support the “SPECIALTY NETWORK ACCESS FEE”.
Continuing development of policies, procedures and financial controls to improve efficiency of program operation and
enhancement of reimbursement to providers. Through efficiencies built into this process, additional populations that were
migrated into managed care the additional populations followed seemlessly, but added complexity as the other populations
required additional analysis of utilization and pricing. With the additional ACA- section 1202, primary care uplift payment
responsibilities the complexities of this duty has increased the number of variables in the SNAF as well as all the moving
parts of the ACA PCP uplift.
Individual tasks related to the duty:
•
•
•
•
•
•
•
•
•
•
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•
Duty 3
Work with individual providers and Medicaid Managed Care plans as necessary to reconcile payments and distributions. Orient managed care financial
staff in the complexities of the migrated populations.
Develop the supplemental payment funding pool that supports provider payments through the managed care payer system.
Compute individual provider commercial rate payment factors.
Use skills in formal logic and reasoning, mathematics and statistics to design analytical products to support the overall system design and the various
reporting requirements of the program.
Use skills in writing and basic composition for communicating complex and technical information to senior management and to internal and external
parties.
Research federal and state regulations pertaining to managed care upper payment limits and intergovernmental transfers under the Medicaid statute.
Correspond with Public Entities on supplemental payment distributions and all other required financial transactions including managed care entities and
primary care providers contracted with the managed care organizations.
Prepare all required documentation to process payment, distribution and refunding of transactions. Documentation and research of payments through the
Encounter data system for the primary care uplift payments required by section 1202 of ACA.
Develop procedures to promote the financial integrity of system operations and technical compliance with generally accepted actuarial methods and
procedures.
Respond to and manage all program audits.
Maintain advanced professional computing and data analysis skills with multiple software packages including “bi-query” Hummingbird packages,
Microsoft Office software, SPSS and maintain general working knowledge of Computer hardware and MMIS systems as necessary to competently
produce needed analytical products.
Use skills in formal logic and reasoning to produce objective evidence-supported analytical products demonstrating impact of these state-wide programs
on Michigan’s Medical safety-net system.
Research federal and state regulations pertaining to managed care rules for supplemental rates paid pursuant to the Affordable Care Act
General Summary:
Percentage:
5
Conducts all analysis and maintains all operational functions to support the “DENTAL ADJUSTMENT PAYMENT
PROGRAM FOR ENHANCED REIMBURSEMENT (DAPPER)”. Continuing development of policies, procedures and
financial controls to improve efficiency of program operation and enhancement of reimbursement to providers.
Individual tasks related to the duty:
•
•
•
•
•
•
•
•
•
•
•
•
•
•
Write new policies, revise existing policies to clarify and/or expand on operational control procedures, methods for payment computation and terms of
provider participation.
Research federal and state regulations pertaining to Intergovernmental Transfers under Medicaid statutes.
Responsible for maintaining current knowledge of and acting as subject-matter expert for Medicaid Special Financing regulations and for advising senior
management in this area.
Write and execute queries (Bi-Query) to extract individual provider claims information from the Michigan Medicaid Data Warehouse.
Maintain advanced professional computing and data analysis skills with multiple software packages including “bi-query” Hummingbird packages,
Microsoft Office software, SPSS and maintain general working knowledge of Computer hardware and MMIS systems as necessary to competently
produce needed analytical products.
Calculate the quarterly distribution of provider supplemental payments for the fee-for-service and managed care payer systems.
Utilize database and spreadsheet products to organize claims data and to facilitate analytical examination of this information.
Use skills in formal logic and reasoning, mathematics and statistics to design analytical products to support the overall system design and the various
reporting requirements of the program.
Use skills in writing and basic composition for communicating complex and technical information to senior management and to internal and external
parties.
Correspond with Public Entities on supplemental payment distributions and all other required financial transactions.
Prepare all required documentation to process payment, distribution and refunding transactions.
Develop procedures to promote the financial integrity of system operations and technical compliance with generally accepted actuarial methods and
procedures.
Respond to and manage all program audits.
Use skills in formal logic and reasoning to produce objective, evidence-supported analytical products demonstrating impact of these state-wide programs
on Michigan’s Medical safety-net system.
Duty 4
General Summary:
Percentage:
5
Conducts all analysis and maintains all operational functions to support the “SPECIAL NEEDS ACCESS PROGRAM”
(SNAP). Continuing development of policies, procedures and financial controls to improve efficiency of program operation
and enhancement of reimbursement to providers.
Individual tasks related to the duty:
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
Write new policies, revise existing policies to clarify and/or expand on operational control procedures, methods for payment computation and terms of
provider participation.
Position will be responsible for calculating the State-Wide “Average Commercial Rate” for dental services using acceptable mathematical procedures;
position will also be responsible for drafting rate-development procedures and policy and communicating policy and procedures as necessary with dental
providers, insurance carriers and other areas of DCH.
Research federal and state regulations pertaining to Intergovernmental Transfers under Medicaid statutes.
Responsible for maintaining current knowledge of and acting as subject-matter expert for Medicaid Special Financing regulations and for advising senior
management in this area.
Write and execute queries (Bi-Query) to extract individual provider claims information from the Michigan Medicaid Data Warehouse.
Maintain advanced professional computing and data analysis skills with multiple software packages including “bi-query” Hummingbird packages,
Microsoft Office software, SPSS and maintain general working knowledge of Computer hardware and MMIS systems as necessary to competently
produce needed analytical products.
Calculate the quarterly distribution of provider supplemental payments for the fee-for-service and managed care payer systems.
Utilize database and spreadsheet products to organize claims data and to facilitate analytical examination of this information.
Use skills in formal logic and reasoning, mathematics and statistics to design analytical products to support the overall system design and the various
reporting requirements of the program.
Use skills in writing and basic composition for communicating complex and technical information to senior management and to internal and external
parties.
Correspond with Public Entities on supplemental payment distributions and all other required financial transactions.
Prepare all required documentation to process payment, distribution and refunding transactions.
Develop procedures to promote the financial integrity of system operations and technical compliance with generally accepted actuarial methods and
procedures.
Respond to and manage all program audits.
Use skills in formal logic and reasoning to produce objective, evidence-supported analytical products demonstrating impact of these state-wide programs
on Michigan’s Medical safety-net system.
Duty 5
General Summary:
Percentage:
10
Various projects as assigned.
•
•
Primary Care Incentive Payments to Managed Care Entities and Providers pursuant to section 1202 of the Affordable
Care Act & Various Affordable Care Act related projects as assigned & other duties as assigned.
Report and study data anomalies in Medicaid reported data from Health Plans and as well as providers.
Individual tasks related to the duty:
•
•
•
•
•
•
•
•
•
•
•
•
Conducts data research and produce analytical products in response to legislative inquiries
Conduct data research and produce analytical products in response to FOIA inquiries
Conduct data research and produce analytical products in response from the Governor's office
Conduct data research and produce analytical products relating to Medicaid enrollment and eligibility
Assist rate specialist as needed with research and analysis of HRA/GME and HMO capitation rates.
Work with individual providers and Medicaid Managed Care plans as necessary to reconcile payments and distributions
Develop the supplemental payment Rate Differential calculations (rate floor and ceiling) following established accounting principles and federal mandates.
Compute individual provider PCP rate payment totals
Develop the supplemental payment Rate Differential calculations (rate floor and ceiling) following established accounting principles and federal mandates.
Compute individual provider PCP rate payment totals and correspond with managed care entities providing instruction in calculations and process.
Build on knowledge based on current position for developing skills in formal logic and reasoning, mathematics and statistics in the design work to
implement this analytical process assessing appropriate monies to providers based on services reported.
Prepare all required documentation to process payment, distribution and refunding of transactions.
Duty 6
General Summary:
Percentage:
5
Medicaid Outreach Activities
Individual tasks related to the duty:
•
•
Research and analyze new funding opportunitites to increase reimbursement rates for Medicaid programs through allowable federal leveraging
mechanisms.
Research and analyze new opportunitites to maintain and increase access to services for Michigan Medicaid enrollees through improved funding and
federal leveraging.
16. Describe the types of decisions made independently in this position and tell who or what is affected by those decisions.
This position involves making decisions for the department, Medicaid providers, the Public Entities and the Medicaid Health
plans. There is a wide latitude for independent decision making impacting the department's mission as it pertains to the
operation of all assigned programs. Types of decisions are tactical in nature and would include (a) technical matters on
database development and computational methods; (b) day-to-day issues that pertain to and smooth program operation, and
(c) provider compliance with the programs rules and procedures. Individuals and groups impacted by these decisions
include participating units of local government (Public Entities), individual participating providers/provider groups,
department/agency management and Medicaid Beneficiaries. Decisions impact the amount of supplemental payments
made to participating providers, the timing and extent to which providers do participate in the programs and the eligibility of
providers to participate based on their compliance with program rules and procedures. Advanced knowledge on design and
execution of analytic products using professional computing and software skills.
17. Describe the types of decisions that require the supervisor's review.
Decisions which are likely to have political impacts on the agency including large-scale provider application rejection,
methodology changes in rate calculations and various audit or other inquiries that may be political in nomenclature.
18. What kind of physical effort is used to perform this job? What environmental conditions in this position physically exposed to on the job?
Indicate the amount of time and intensity of each activity and condition. Refer to instructions.
Work is performed in an office setting. Substantial time is spent working on a personal computer. Time lines and political
impact of various duties can create significant stress. Occasional travel may be required.
19. List the names and position code descriptions of each classified employee whom this position immediately supervises or oversees on a fulltime, on-going basis.
Additional Subordinates
20. This position's responsibilities for the above-listed employees includes the following (check as many as apply):
N
Complete and sign service ratings.
N
Assign work.
N
Provide formal written counseling.
N
Approve work.
N
Approve leave requests.
N
Review work.
N
Approve time and attendance.
N
Provide guidance on work methods.
N
Orally reprimand.
N
Train employees in the work.
22. Do you agree with the responses for items 1 through 20? If not, which items do you disagree with and why?
Yes.
23. What are the essential functions of this position?
This position serves as the agency's policy expert and operations analyst for the two variations of the Physician Adjuster
Payment program. One variation is for fee-for-service claims. The second variation works through the managed care
organizations.
24. Indicate specifically how the position's duties and responsibilities have changed since the position was last reviewed.
This position has grown in complexities since the last review especially related to the distinct subject matters requiring expert
knowledge as well as skill involving interaction that is politically sensitive. Because of the experience base involving
the core functions of this position, this position expanded a bit in the set of responsibilities under the Affordable Care Act
and additional complexity with current programs due to changing system design and State requirements pursuant to new
regulations related to the Affordable Care Act and State legislation implementing health reform.
The position has
unique, expert status in Intergovernmental Transfer mechanisms allowable under Federal and State rules governing
Medicaid, manual payment project management and design and general analytical functions related projects of this
nomenclature. Position has lead responsibility for very complex analysis involving numerous variables incorporating all
these related issues and their budgetary impact, particularly in identifying unexpected cost growth outliers
25. What is the function of the work area and how does this position fit into that function?
The Medicaid Actuarial Division has a broad range of duties including: (1) All actuarial research related to the annual
Medicaid budget process and for responding to information requests from the legislature, other departments and the governor
on Medicaid and Medicaid-related eligible recipients and cost; (2) Capitation rate-setting functions associated with
the Medical Services Administration and certain operational aspects of capitation payments and other special payments; (3)
Special financing policy and calculations for physicians; (4) Data warehouse development guidance; (5) MSIS reporting
guidance; (6) Certain functions related to the Medicare Part D and Medicaid Program interfaces; (7) Analysis of external
financial organizations or programs as requested from time to time; (8) Analysis of physician fee screens; (9) Waiver
development and maintenance; (10) planning and implementation of various provisions of the Affordable Care Act related to
Medicaid. This section is responsible for aspects of items 1, 2, 3 and 10 and for items 4, 5, 6, 7 and 8 in their entirety.
Development and implementation of capitation payments and other payments or related procedures for the Medicaid Health
Plans, the mainstream delivery system for Medicaid eligible recipients, are core responsibilities of the section. This position
is integral to functions 1, 2, 3, 7, 8 and 10
26. What are the minimum education and experience qualifications needed to perform the essential functions of this position.
EDUCATION:
Bachelors degree in mathematics, business or the social sciences with some course work in statistics. Work experience with
health care statistics may substitute for the course work. A masters degree would be a plus but is not required.
EXPERIENCE:
A minimum of four years of progressively increasing responsibility in health care actuarial or finance work are prerequisites
for this position.
KNOWLEDGE, SKILLS, AND ABILITIES:
Working knowledge of descriptive and inductive statistics, familiarity with health care financing issues, spreadsheet software
skills, database development and management skills, ability to communicate orally and in writing clearly and concisely.
Experience in a private or public sector health organization in actuarial work would be a plus but is not required if other skills
and background compensate.
CERTIFICATES, LICENSES, REGISTRATIONS:
None.
NOTE: Civil Service approval does not constitute agreement with or acceptance of the desired qualifications of this position.
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.
Date
TO BE FILLED OUT BY APPOINTING AUTHORITY
Indicate any exceptions or additions to the statements of employee or supervisors.
I certify that the entries on these pages are accurate and complete.
Appointing Authority
Date
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.
Employee
Date