CS-214 Position Description Form s19

CS-214 1. Position Code REV 8/2007 DEPTALTAJ91N State of Michigan Civil Service Commission Capitol Commons Center, P.O. Box 30002 Lansing, MI 48909 Federal privacy laws and/or state confidentiality requirements protect POSITION DESCRIPTION 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 Health and Human Services, Medical Services Administration 3. Employee Identification Number 9. Bureau (Institution, Board, or Commission) Bureau of Medicaid Operations & Actuarial Services

4. Civil Service Classification of Position 10. Division Departmental Specialist 2 Actuarial

5. Working Title of Position (What the agency titles the 11. Section position) Rates & Encounter Data Departmental Specialist 2

6. Name and Classification of Direct Supervisor 12. Unit Julie DuPuis, SAM 15

7. Name and Classification of Next Higher Level Supervisor 13. Work Location (City and Address)/Hours of Work Penny Rutledge, SDA17 400 S. Pine, Lansing 48933 M – F 8 A.M. – 5 P.M 14. General Summary of Function/Purpose of Position This position serves as the state’s specialist for Performance Monitor Reporting and the Encounter Quality Initiative for Medicaid Health Plan Encounter reporting. This position also functions as the state expert in subject matter relating to encounter and Fee For Service claim and financial aspects of MIChild Cost settlement. This individual is responsible for specialized complex analyses of data from various MDCH databases, and the MDCH CHAMPS data warehouse, with particular focus on Medicaid encounter data. These analyses are specifically used to monitor quality of data; health plan reporting, and determining utilization patterns and access to care for Medicaid recipients; provide data and specific detailed complex analyses for research projects essential in providing information for administrative and policy decisions. This individual is responsible for monitoring the submission and quality of data from managed care entities; on-site health plan visits; preparing and presenting analytical findings; and compiling, manipulating, and analyzing large data sets. Encounter data currently drives $5 billion in annual capitation payments, and will increase significantly as more Medicaid programs and providers enter Managed Care contracts with the department. The position is also responsible for preparing and proposing MIChild settlement offers. An annual $13 Million settlement to care for CSHCS children as well as those qualifying for MIChild. For Civil Service Use Only

15. Please describe your assigned duties, percent of time spent performing each duty, and explain what is done Page 1 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 30 Manage the Encounter Quality Initiative through extensive contacts with the Managed Health Care Plans, MDCH data warehouse and the State’s Medicaid Actuary providing complex and detailed information to ensure that quality data is submitted, reviewing the timeliness and completeness of the data.

Individual tasks related to the duty.  Develop and maintain complex procedures that involve understanding specific data elements required for submission by the Medicaid Health Plans in their encounter data. Understanding of error reports and have the ability to communicate those finding to the health plans and assist in technical corrections.  Communicate schedules, deadlines, and data requests between MHP’s, Milliman, and Optum.  Analyze Milliman findings using the State Data Warehouse.  Develop corrective action plans for Medicaid Health Plans (MHPs).  Conduct site visits to the 13 MHPs explaining the complexities of the reporting, the findings and differentials between the health plan data systems and Medicaid encounter submissions.

Duty 2 General Summary of Duty 2 % of Time 10 Prepare and propose MIChild settlement offers to Blue Cross Complete, a $70M program involving examination and analysis of FFS and Encounter data sets. Individual tasks related to the duty.  Compile, manipulate, and analyze extremely complex large encounter data sets with multiple fields and factors.  Identify duplicate encounters in the State Data Warehouse.  Communicate with personnel at Blue Cross Complete reconciling capitation payments and encounter data.  Prepare settlement proposal letter.

Duty 3 General Summary of Duty 3 % of Time 20 Serves as a resource for MDCH and external staff and health plans regarding complex data issues, participates in workgroups and discussions on data warehouse maintenance as well as complex business questions.

Individual tasks related to the duty.  Serves as a specialized resource for state staff on matters relating to relational database and ad hoc query software.  Prepares and presents analyses and reports to MDCH administrators and managers.  Prepares and presents processes, reports and analyses to MDCH and Medicaid Health Plan staff.  Participates in or facilitates workgroup meetings, i.e., BI/Query User Group, Bi-Monthly Medicaid Health Plan Meetings.  Serves as a resource for MDCH and external staff on matters related to encounter and fee-for-service data, and data issues resulting from implementation of rules and regulations.·

Duty 4 General Summary of Duty 4 % of Time 20 Evaluates MDCH Warehouse data quality.

Individual tasks related to the duty.  Conducts on-site visits with managed care entities to review Data Quality Improvement Plans (DQIPs).  Performs ongoing analyses of encounter and fee-for-service data to evaluate quality, accuracy and completeness of data; and determine utilization patterns and access to care for various health care services.  Utilizes various tools for accessing and modifying Data Warehouse data, including BI/Query and MS Access.  Evaluates reasonability edits on the data including frequency distributions, comparisons to prior history, benchmark comparisons, to identify data quality issues and maintain a thorough understanding of the data quality of each health plan in comparison to the minimum standards established by the State of Michigan.  Creates ad hoc reports, using relational database applications, to evaluate the presence of potential data issues.  Participates in user acceptance testing of MDCH Data Warehouse.

Duty 5 General Summary of Duty 5 % of Time 20 Performance Monitoring Report-Responsible for securing data needed for the Managed Care Division, Quality Improvement and Program Development Section. This reporting involves creation and development of complex queries pulling extensive diagnosis codes, measuring the accuracy of the data, and understanding the various measures expected for each plan.

Individual tasks related to the duty.  Compile, manipulate, and analyze extremely complex large encounter data sets  Simplify the complex information into layman’s terms for ease of translation to program staff  Participate in a workgroup to hone in on the data needed fulfilling the need of the specific area measurement for quality.  Participate in Manage Care Plan staff meetings presenting material and evaluation of the data submitted by the plans for creating the required HEDIS measures.  MDCH CHAMPS data warehouse understanding query building and results  Excel spreadsheet complex functions

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. Developing or conducting analyses of complex data, preparing reports, and resource information; setting priorities in performing these activities; developing work plans and processes for change and improvements, developing complex relational database applications to compile, manipulate, query, report and analyze large data sets; monitoring data submissions, and evaluating managed care entity encounter testing.

17. Describe the types of decisions that require your supervisor’s review. Approval of methodologies for complex data analysis to assure it addresses management’s needs. Issues or problems that have program-wide implications or impact areas other than the specific assigned area of responsibility. Final authorization allowing managed care entities to submit production encounter data.

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. The majority of work is performed in an office setting and requires use of computer equipment at least 75% of the time. There will be some travel for on-site visits, meetings, and attending seminars as appropriate.

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

20. My responsibility for the above-listed employees includes the following (check as many as apply):

Complete and sign service ratings. Assign work. Provide formal written counseling. Approve work. Approve leave requests. Review work. Approve time and attendance. Provide guidance on work methods. Orally reprimand. 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? Agree

23. What are the essential duties of this position? Performing complex and specialized analyses of encounter, fee-for-service, and other data, with particular emphasis on lead screening data and reports, and monitoring quality of data in the MDCH Data Warehouse. Evaluating human subject data from various databases and utilizing Universal Client Identifier tools to establish linkages across system databases. Supporting the functions of the MDCH Security Officer.

24. Indicate specifically how the position’s duties and responsibilities have changed since the position was last reviewed. The job duties are more appropriate for this work area.

25. What is the function of the work area and how does this position fit into that function? MDCH has established a data collection process to support the management of its Medicaid managed care program. Managed care entities submit data into the State Data Warehouse, which also houses numerous MDCH databases. This position lies with the Data Analyses and Quality Assurance Section and is responsible for performing complex analytic tasks related to use of encounter, fee-for-service, and other MDCH data stored in the warehouse. The section and position is responsible for analyzing test data from all managed care entities including mental health, substance abuse, Medicaid managed care plans, county health plans and MIChild. This section is responsible for assuring MDCH’s compliance to the HIPAA Security Rule. This position will support the functions of the MDCH Security Officer.

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. A degree in a health related field, engineering, social science or computer science is desirable.

EXPERIENCE: Three years of professional business and administrative experience, including one year of experience equivalent to the experienced (P12) level in state service.

KNOWLEDGE, SKILLS, AND ABILITIES: High attention to detail Ability to handle multiple tasks simultaneously Strong communication skills – both oral and written

CERTIFICATES, LICENSES, REGISTRATIONS:

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