Occ. Code 6815500

DIRECTOR REGULATORY AFFAIRS, M-5

New York State Department of Civil Service

Classification Standard

BRIEF DESCRIPTION OF CLASS

The Director Regulatory Affairs recommends and establishes agency policy regarding compliance and regulatory programs administered pursuant to the NYS Workers Compensation Law, the NYS Disability Benefits Law, Rules and Regulations and other related statutes and ensures that all parties are in compliance.  The incumbent has managerial and supervisory responsibility for the smooth and efficient coordination and functioning of the Boards regulatory offices. Director Regulatory Affairs is classified only in the Workers Compensation Board.

DISTINGUISHING CHARACTERISTICS

DIRECTOR REGULATORY AFFAIRS:  one-position class; directly supervises managers at the M-3 and M-4 levels and directs the activities of the Division of Regulatory Affairs on a Statewide basis to ensure that all parties are in compliance with the workers compensation, disability benefits, and related laws.

ILLUSTRATIVE DUTIES

· Ensures that the Division monitors compliance on an ongoing basis, penalizes those parties who are not in compliance and refers cases for fraud investigation when necessary.

· Oversees the disputed medical bill and arbitration process, medical provider compliance, the authorization of medical providers, Independent Medical Exam (IME) entities, the development and maintenance of medical fee schedules and Preferred Provider Organization (PPO) programs.

· Is responsible for the solvency of the Uninsured Employers Fund (UEF) and the Special Fund for Disability Benefits by providing strategic review of activities involving the investigation and assessment of fines for non-compliance and the investigation and adjudication of no-insurance claims,  plans and directs high-level activities involving the collection of penalties and payments made out of the UEF or the Special Fund for Disability Benefits with a view towards improving collection rates; assists in determining the necessary levels of assessments and reserves to ensure proper payments from the Funds.

· Represents the Chairman in meetings with representatives from other State agencies, legislators, private businesses/corporations, employers, insurance carriers, labor and management groups, physicians, lawyers, and other interested parties by addressing concerns and providing information either verbally or in writing.

· Serves as the agencys spokesperson on employer compliance, disability benefits, various health management programs, UEF, and the Special Fund for Disability Benefits; prepares and presents public addresses on behalf of the Chairman on issues related to the Workers Compensation Board and its regulatory programs.

· Represents the Board before the Compensation Insurance Rating Board to provide information concerning the validity of employer coverage, general Board procedures and responding to questions.

· Serves as a member of the agencys Legislative Initiative Committee recommending legislation and providing input into proposals dealing with compensation insurance coverage, the enforcement of the Workers Compensation Law and related areas.  Identifies and recommends changes where legislation needs amending or new legislation needs to be proposed.  Presents and defends recommendation, strategies and agency policies.

· Establishes the manner and scope of the activities of each Bureau within the Division; formulates policy, establishes goals, objectives and priorities and is responsible for planning for effective implementation, provides overall direction and coordinates the work of these offices.

· Directs the work coming into the Division by establishing policy, setting general priorities, addressing issues referred by executive management, and establishing procedures and standards by which professional staff adhere.

· Coordinates the operations of the Division where its findings affect the operations of another Office within the Division by identifying the problem and a corresponding solution.  Directs and coordinates a wide range of activities to ensure smooth and efficient functioning of the inter-related Bureau activities.

· Provides broad-based expertise to assist Bureau Heads to implement revised or new policy initiatives in an effective and efficient manner.

· Oversees the processes and procedures utilized by Bureau of Health Management staff related to the rating and re-rating of physicians, registering independent medical examination entities and licensing medical facilities.

· Directs the investigation and processing of complaints concerning health provider practitioners and provider compliance actions that can result in the suspension and revocation of a providers authorization, license or registration.

· Oversees the processes and procedures utilized by Disability Benefits Bureau staff related to disability benefits coverage and claims activities including claims processing, plans acceptance and insurance compliance per the Disability Benefits Law.

· Oversees the processes and procedures utilized by Bureau of Compliance staff related to monitoring employer coverage compliance, investigating employers who may be out of compliance, and collection of penalties.

· Serves as the Chairs liaison with various groups on matters related to health services and practices. 

MINIMUM QUALIFICATIONS

Promotion:  two years of permanent competitive service as Director of Disability Benefits, Director of Health Management, Assistant Director of Self Insurance,  Assistant Director of Claims, Director of Rehabilitation and Social Services; or one year of permanent competitive service as Director of Compliance, Director Workers Compensation Regulatory Services or Director Self Insurance..

Date:  3/10

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 are those which were required for appointment at the time the Classification Standard was written.