The Policy Manager supports the Centers for Medicare and Medicaid Services (CMS) by tracking new Medicaid and Children's Health Insurance Program (CHIP) regulations and CMS sub-regulatory guidance. This position is responsible for incorporating updates into the medical review and data processing review procedures for the Payment Error Rate Measurement (PERM) program. The Policy Manager will be the Task Leader of the Policy Group, which includes the Policy Specialist, Policy Analyst with support from the Senior Data Processing Reviewers and the Medical Reviewers. This position works collaboratively with all related Task Leaders and supports team efforts to ensure high quality standards and results are achieved.
ESSENTIAL DUTIES AND RESPONSIBILITIES
Essential duties and responsibilities include the following. Other duties may be assigned.
Responsible for the integration of CNI Core Competencies into daily functions, including: commitment to integrity, knowledge / quality of work, supporting financial goals of the company, initiative / motivation, cooperation / relationships, problem analysis / discretion, accomplishing goals through organization, positive oral / written communication skills, leadership abilities, commitment to Affirmative Action, reliability / dependability, flexibility and ownership / accountability of actions taken.
Manages the Policy Group to accomplish the scope of work requirements for tracking Medicaid and CHIP regulations and the database of policies and policy updates.
Conducts policy analysis, qualitative analysis and research for the PERM program.
Maintains deliverables tracking tool and communicates deadlines and priorities to staff and client.
Drafts and edits reports, user manuals, plans, and training materials. Develops documentation and trains staff on the use of custom software applications.
Effectively communicates relevant project information and ensures that team members are well-informed of project changes and updates.
Assists CMS with transforming the PERM program to comply with the new laws and regulations.
Works collaboratively with the Policy Specialist, Senior Data Processing Reviewers and Medical Reviewers to assure appropriately collected state and federal policies required for Medicaid and CHIP reviews are correctly processed and available in the State Medicaid Error Rate Findings (SMERF) website.
Works collaboratively with the Policy Specialist to research and track all new regulations on a weekly basis. Prepares quarterly reports for CMS describing the impact of new regulations on the PERM project.
Identifies new regulations and sub-regulatory guidance that may have a potential impact on PERM. Notifies CMS through bi-weekly meetings and issue alerts.
Maintains Policy Manual, Review Manual and States’ Standard Operating Procedures (SOP).
Works collaboratively with policy analyst to collect and process State policies, uploading said policies into SMERF to generate as Master Policy Lists (MPL) for each State.
Disseminates individual MPL to the PERM State representatives to obtain approval of the collected policies during pre-cycle activities as being comprehensive and accurate for the RC’s review purposes.
Facilitates the RC’s Collaboration and Orientation sessions with the States, and obtains the Data Use Agreements and any other documents needed to secure the RC’s access to all State systems required to complete DP reviews.
Keeps Project Director informed of new and impending regulations. Serves as a liaison with PERM Data Processing and Medical Review Task Leaders.
Develops clear communication plans for States regarding implementation of new processes resulting from new regulations or changing program requirements.
Reviews an edits meeting agendas and minutes prepared by subordinate staff to ensure such documents are accurate and distributed timely. Documents, assigns, and ensures compliance with action items for a variety of meetings with client and/or external business partners.
Facilitates the RC’s collaboration and orientation sessions with the states, and obtains the data use agreements and any other documents needed to secure the RC’s access to all state systems required to complete DP review.
Responsible for aiding in own self-development by being available and receptive to all training made available by the company.
Plans daily activities within the guidelines of company policy, job description and supervisor’s instruction in such a way as to maximize personal output.
Responsible for keeping own immediate work area in a neat and orderly condition to ensure safety of self and coworkers. Will report any unsafe conditions and/or practices to the appropriate supervisor and human resources. Will immediately correct any unsafe conditions to the best of own ability.
EDUCATION / EXPERIENCE
Bachelor's degree and a minimum of five (5) years relevant experience, or equivalent combination of education / experience. Master’s degree preferred.
CERTIFICATES / LICENSES / REGISTRATION
U.S. Citizens / Green Card due to government or federal requirement
Ability to obtain government security clearance
JOB SPECIFIC KNOWLEDGE / SKILLS / ABILITIES
Considerable program knowledge and understanding of Medicaid and CHIP principles and practices
Thorough understanding and knowledge of information technology security and Health Insurance Portability and Accountability Act (HIPAA) policies for dealing with Personal Health Information and personally identifiable information
Basic knowledge and understanding of medical coding rules and guidelines
Skilled proficiency in the use of Microsoft Office Suite (i.e., Word, Excel, Outlook, Project, etc.), Microsoft SharePoint, and custom database applications used in support of the PERM program and the ability to quickly grasp customized software systems
Exceptional organization skills with ability to effectively manage multiple projects and priorities
Skilled in facilitating teamwork and coordinating efforts for the successful achievement of goals
Excellent supervisory skills with ability to effectively lead, mentor and train others
Solid organizational and leadership skills relevant to carrying out day-to-day responsibilities
Excellent customer service and relationship-building skills
Excellent verbal and written communication skills with solid presentation skills
Ability to manage multiple projects and priorities and to meet specified deadlines
Ability to schedule, plan, and lead meetings
Ability to implement a proactive approach to problem-solving
Ability to interact professionally with team members, corporate management, and clients of all levels
Demonstrated ability to work under pressure and meet tight deadlines
Ability to effectively work both independently and in a highly collaborative, team environment
Ability to read, analyze, and interpret general business periodicals, professional journals, technical procedures, or governmental regulations. Ability to write reports, business correspondence, and procedure manuals. Ability to effectively present information and respond to questions from groups of managers, clients, customers, and the general public.
Ability to work with mathematical concepts such as probability and statistical inference, and fundamentals of plane and solid geometry and trigonometry. Ability to apply concepts such as fractions, percentages, ratios, and proportions to practical situations.
Ability to define problems, collect data, establish facts, and draw valid conclusions. Ability to interpret an extensive variety of technical instructions in mathematical or diagram form and deal with several abstract and concrete variables.