Management Analyst (Medical Fiscal Consultant)

Full Job Description

Corrections professionals who foster a humane and secure environment and ensure public safety by preparing individuals for successful reentry into our communities.

To be considered for the position, you must meet the following qualification requirements. Education There is no substitution of education for specialized experience for this position.

OR Experience You must have at least one year of specialized experience equivalent in difficulty and complexity to the next lower grade level.

To be creditable, this experience must have equipped the applicant with the particular qualifications to perform successfully the duties of the position, and must typically be in or related to the position to be filled.

Some examples of this qualifying experience are: Experience in database management systems to track performance measures, problems and weaknesses, program evaluation, and compliance with established policy and regulatory requirements.

Experience in conducting research to include identifying issues to examine, determining the methodology to apply, analyzing data, and employing relevant computer and statistical tools and communicating the findings to management officials.

Experience in communicating effectively with institutional staff, department heads, executive level staff, Regional and Central Office staff, outside government entities and stakeholders on issues relating to an organization's audit and review process.

AND Selective Placement Factor Applicants applying for this position MUST also possess the following Selective Placement Factor.

In the event you do not possess the Selective Placement Factor, you will be found ineligible for the position.

The applicant must have knowledge and understanding of Centers for Medicare and Medicaid Services (CMS) guidelines, rules, procedures, and regulations as well as the ability to apply those guidelines, rules, procedures, and regulations in establishing guidelines and resolving disputes involving the adjudication of medical claims in this agency.

NOTE: Applicants must state their experience in their resume to be found qualified. If applicable, credit will be given for paid and unpaid experience.

To receive proper credit, you must show the actual time (such as the number of hours worked per week) spent in activities.

**Your eligibility for consideration will be based on your responses to the questions in the application.** Major Duties:

Involved in policy development and analysis. Development of divisional planning, goals, and objectives and comprehensive fiscal analysis of effectiveness and efficiency of the health services program.

Develops program needs based on data obtained from various programmatic areas and data sources including sensitive Medical Data (SMD) and the Financial Management Information System (FMIS).

Involved in program review analysis (strategic planning, management assessment, and program analysis) of health services program functions.

Involved in the development of national health care and operational policies, manuals, and program statements.

Provides support and assistance in the development of medical fiscal policies and procedures.

Serves as the Contracting Officer's Technical Representative (COTR) for a national third-party medical claims adjudication services contact.

Responsible for establishing standardized adjudication rules for the agency in those instances where CMS guidelines call for payment determination at the agency's discretion.

Along with all other correctional institution employees, incumbent is charged with responsibility for maintaining security of the institution.

The staffs orrectional responsibilities precede all others required by this position and are performed on a regular and recurring basis.