Occ. Code 6662410

RESOURCES & REIMBURSEMENT PROGRAM DEVELOPMENT SPECIALIST 1, GRADE 18	6662410
RESOURCES & REIMBURSEMENT PROGRAM DEVELOPMENT SPECIALIST 2, GRADE 23	6662420
RESOURCES & REIMBURSEMENT PROGRAM DEVELOPMENT SPECIALIST 3, GRADE 27	6662430

New York State Department of Civil Service

Classification Standard

BRIEF DESCRIPTION OF CLASS SERIES

Resources & Reimbursement Program Development Specialists assist in the development, evaluation, and maintenance of statewide revenue and reimbursement programs and systems.  Incumbents research and analyze new or proposed State and federal laws, rules, and regulations to determine the impact on agency programs and initiatives; develop, revise, and update policy, procedure, and process guidance materials; provide technical assistance to field agents and provider agencies; and monitor program operations to improve fiscal resources, maximize revenue, and ensure compliance with applicable laws, rules, and regulations. 

          These positions are classified in the Office of Mental Health and the Office for People With Developmental Disabilities.  

DISTINGUISHING CHARACTERISTICS

          RESOURCES & REIMBURSEMENT PROGRAM DEVELOPMENT SPECIALIST 1: full performance level; under the supervision of a higher-level Resources & Reimbursement Program Development Specialist, assists in the development, evaluation, and maintenance of resources and reimbursement programs and systems.

          RESOURCES & REIMBURSEMENT PROGRAM DEVELOPMENT SPECIALIST 2: supervisory level; supervises Resources & Reimbursement Program Development Specialists 1 and other subordinate staff; and develops, evaluates, and monitors resources and reimbursement program operations, policies, financing methodologies, and systems. 

          RESOURCES & REIMBURSEMENT PROGRAM DEVELOPMENT SPECIALIST 3: second supervisory level; supervises, coordinates, and directs the activities of Resources & Reimbursement Program Development Specialists 1 and 2, and the operations of a statewide resources and reimbursement program. 

RELATED CLASSES

Resources & Reimbursement Agents conduct financial investigations, determine payment sources, and develop and submit claims for the cost of care of individuals receiving care and/or treatment in State facilities and programs. 

ILLUSTRATIVE DUTIES

        RESOURCES & REIMBURSEMENT PROGRAM DEVELOPMENT SPECIALIST 1

Assists in the development, evaluation, and maintenance of revenue and reimbursement programs and systems. 

· Assists higher-level Resources & Reimbursement Program Development Specialists in the design and development of reimbursement methodologies, rates for services, and systems documentation and requirements; and in the resolution of reimbursement issues between individuals served, local, not-for-profit, county, and/or other State agencies.

· Researches and analyzes new or proposed State and federal laws, rules, regulations; assesses financial impact on agency programs and initiatives, including revenue projections; determines if agency programs qualify for reimbursement; and drafts position papers, reports, and/or presentations based on findings. 

· Researches reimbursement methodologies of other states, and makes recommendations to improve fiscal resources and maximize revenue.

· Reviews and monitors financial program data from field agents, provider agencies, and contractors to ensure accuracy, use of appropriate rates of payment, and compliance with billing standards, rules, and regulations. 

· Resolves billing issues with field agents and provider agencies; identifies rate errors and reasons for reimbursement denials; and makes systems corrections as necessary. 

· Monitors, tracks, and reports on allocation and spending accounts for programs and services; and assists in the resolution of discrepancies.  

· Acts as liaison or coordinator with agency staff and other agencies; and provides information on sources of revenue or funding.

· Provides technical assistance to field agents and provider agencies; and interprets applicable laws, rules, and regulations. 

May provide training relative to resources and reimbursement program operations, changes, and processes to agency and provider staff as needed.    

        RESOURCES & REIMBURSEMENT PROGRAM DEVELOPMENT SPECIALIST 2

Performs the same duties and activities as a Resources & Reimbursement Program Development Specialist 1, and:

Supervises Resources & Reimbursement Program Development Specialists 1 and other subordinate staff; determines staff assignments and reassignments; approves leave and tracks time and attendance; completes performance evaluations; and identifies training needs and arranges for the provision of training. 

        RESOURCES & REIMBURSEMENT PROGRAM DEVELOPMENT SPECIALIST 3

Performs the same duties and activities as a Resources & Reimbursement Program Development Specialist 2, and:

Supervises, coordinates, and directs the activities of Resources & Reimbursement Program Development Specialists 1 and 2, and the operations of a statewide resources and reimbursement program. 

MINIMUM QUALIFICATIONS

        RESOURCES & REIMBURSEMENT PROGRAM DEVELOPMENT SPECIALIST 1

Open Competitive: bachelor’s degree and two years of experience in the research, development, or implementation of regulations and/or policies related to funding programs for healthcare, mental health, or developmental disabilities services; or completion of a two-year traineeship.

        RESOURCES & REIMBURSEMENT PROGRAM DEVELOPMENT SPECIALIST 2

Promotion: one year of service as a Resources & Reimbursement Program Development Specialist 1.    

RESOURCES & REIMBURSEMENT PROGRAM DEVELOPMENT SPECIALIST 3

Promotion: one year of service as a Resources & Reimbursement Program Development Specialist 2. 

Date:  8/18

NOTE: Classification Standards illustrate the nature, extent, and scope of duties and responsibilities of the classes they describe.  Standards cannot and do not include all of the work that might be appropriately performed by a class.  The minimum qualifications above are those which were required for appointment at the time the Classification Standard was written.  Please contact the Division of Staffing Services for current information on minimum qualification requirements for appointment or examination.