Tentative Classification Standards issued by the Division of Classification & Compensation are shared with the operating agencies of State government for their consideration and comment. Accordingly, this document that you are viewing is subject to change and will be issued in final form at the completion of the review period.

TENTATIVE

 

Occ. Code 0230300

 

                                           

SENIOR HEALTH CARE FISCAL ANALYST, GRADE 18

0230300

ASSOCIATE HEALTH CARE FISCAL ANALYST, GRADE 23

0230400

PRINCIPAL HEALTH CARE FISCAL ANALYST, GRADE 27

0230500

CHIEF HEALTH CARE FISCAL ANALYST, GRADE 29

0230600

 

New York State Department of Civil Service

 

Classification Standard

 

 

BRIEF DESCRIPTION OF CLASS SERIES

 

 

Positions in this title series perform a wide range of specialized activities related to the calculation and maintenance of Medicaid and/or Medicare reimbursement rates.  Incumbents in these positions are responsible for reviewing and/or preparing cost and statistical data reported by various health care providers; completing financial and statistical analysis of health care financing methodologies; conducting financial feasibility studies; calculating appropriate Medicaid and/or Medicare rates of payment; and resolving health care provider rate appeals. 

 

Positions in the title series are classified at the Department of Health (DOH); the Office of Mental Health (OMH); the Office of Mental Retardation and Developmental Disabilities (OMRDD); the Office of Alcoholism and Substance Abuse Services (OASAS); the Office of Children and Family Services (OCFS); and the Office of Temporary and Disability Assistance (OTDA).  Incumbents assist in the total care and confinement of patients and/or consumers referred to the facility.  All incumbents perform various duties and functions in conjunction with the overall operation of a facility and/or location to which they are assigned.

 

DISTINGUISHING CHARACTERISTICS

 

SENIOR HEALTH CARE FISCAL ANALYST: full performance level; perform entry level duties related to reviewing cost and statistical data reported by various health care providers; complete financial and statistical analysis of health care financing methodologies; conduct financial feasibility studies; calculate appropriate Medicaid rates of payment; resolve health care provider rate appeals; and prepare cost reports. 

 

ASSOCIATE HEALTH CARE FISCAL ANALYST: first supervisory level; responsible for more complex assignments and supervision of subordinate staff in one or more activities.

 

PRINCIPAL HEALTH CARE FISCAL ANALYST: second supervisory level or first managerial level of the title series.  Incumbents supervise and direct the activities of several lower-level Health Care Fiscal Analysts.

 

CHIEF HEALTH CARE FISCAL ANALYST: unit head level; supervise a minimum of two Principal Health Care Fiscal Analysts (and their subordinate teams of Associate and Senior Health Care Fiscal Systems Analysts) and plan, assign, supervise, and evaluate the work of staff performing a wide range of specialized activities.

 

ILLUSTRATIVE DUTIES

 

SENIOR HEALTH CARE FISCAL ANALYST

 

Review, analyze, and prepare cost and statistical data reported by various health care providers.

 

·      Review financial information accompanying management contracts, construction applications, and other operational charges for financial feasibility and impact on rates.

·      Review proposed budgets for programs, contracts, grants, and solicitations for consistency with applicable financial requirements of the program.

·      Review and evaluate the cost and statistical data submitted by providers and enter data for the establishment of initial Medicaid reimbursement rates for nursing facilities and specialty rates.

·      Ensure quarterly statistical and ancillary data are properly and accurately reported.  Identify data reporting inconsistencies, and develop related explanations or resolutions. 

·      Determine the impact of any improper reporting and communicate same to provider.

·      Conduct analysis of the billing process to determine compliance with the billing rules by determining the critical aspects of the process that create accurate and complete billing.

 

Complete financial and statistical analysis of health care financing methodologies.

 

·      Prepare written reports on all financial review findings.

·      Review, analyze, and track annual financial reports submitted by licensed providers.

·      Review the weekly Medicaid and Medicare remittance reports.

·      Update the internal website with current reports.

·      Check monthly related websites for updates and newsletters.

·      Prepare reports analyzing inpatient and outpatient billing and remittance data.

·      Ensure the inpatient and outpatient Medicaid and Medicare remittances are run properly and timely.

 

Conduct financial feasibility studies.

 

·      Review applicable statutory and regulatory requirements.

·      Monitor specific billing systems and resolve system problems, including any corrections.

 

Coordinate special projects.

 

·      Analyze special projects and data analysis used by management to support billing functions, monitor certain activities, and comply with initiatives to maximize revenue.

·      Review financial information in applications for feasibility of proposed capital and operating costs and projected revenues.

 

Calculate appropriate Medicaid rates of payment.

 

·      Determine and document billing procedures. 

·      Prepare required manual rate adjustments, and assist and/or prepare analysis for special projects.

·      Develop and coordinate the input of an analytical model for required reimbursement applications.

·      Develop and implement billing applications using PC based software.

 

Resolve health care provider rate appeals.

 

·      Determine application financial issues that should be reviewed by the supervisor.

·      Develop necessary backup information and analyses to resolve outstanding financial issues.

·      Assist in the analysis and resolution of questions raised or adjustments proposed by outside auditors on cost and statistical data used in cost reports. 

·      Resolve potential audit adjustments and communicate fiscal impact of the adjustments to provider personnel. 

·      Provide auditors with materials needed to complete their review. 

·      Assist in preparing responses to potential audit disallowances. 

·      Respond to inquiries from applicants and other interested parties regarding the financial requirements of the program.

·      Respond in writing and verbally to providers and others involved in various areas of Medicaid and/or Medicare.

·      Analyze health facilities complex items of appeal and related justification to determine the appropriateness of Medicaid and/or Medicare rate revision.

 

Provide technical assistance.

 

·      Provide technical assistance to outside consultants and applicants in the development and submission of application financial schedules.

 

 

ASSOCIATE HEALTH CARE FISCAL ANALYST

 

May perform all of the same duties and functions as a Senior Health Care Fiscal Analyst.

 

Develop policies and procedures.

 

·      Develop and maintain policies and procedures for related operations.

·      Develop new program initiatives through collaboration with State agency staffs, local providers, and local governmental unit staffs.

·      Develop program guidelines and criteria for budget/revenue initiatives and analytical data on expected outcomes of initiatives.

·      Establish reimbursement methodologies.

·      Develop procedures and implementation plans.

·      Develop required reports and analysis.

·      Develop criteria for measurement of initiative success.

·      Work with lower-level staff and budget and fiscal management, treatment, field offices, and/or county staff, to monitor revenues of providers using related systems including the revenue management system.

·      Provide recommendations and assistance to management in the development/improvement of policies and procedures on health care financing.

 

Provide audit and review functions.

 

·      Track and assure the filing of required Consolidated Fiscal Reports (CFRs) by Medicaid providers by maintaining CFR submission logs and conducting necessary follow-up on late submissions.

·      Complete desk reviews of CFR filings and conduct necessary follow-up activities with providers on questionable CFR data to assure the accuracy and appropriateness of the reported fiscal data.

·      May develop a process to complete the fiscal review and approval of rate and funding changes.

·      Review the initial proposals for consistency with an agencys operational planning documents and expansion criteria, the character and competence of the operator, and the overall fiscal viability and cost effective feasibility of the proposal.

·      Oversee the approvals received from an agencys fiscal oversight unit or office. 

·      Evaluate the fiscal viability and cost effectiveness of the proposal based on the detailed budgetary information.

 

Perform related studies.

 

·      Prepare timely and accurate reports from Medicaid and/or Medicare, CFR, or client data, in support of rate/fee-setting and Medicaid and/or Medicare revenue monitoring and utilization management duties, as well as proposals for alternative revenue initiatives.

·      Evaluate the fiscal viability and cost effectiveness of the proposal based on the detailed budgetary information.

·      Collect and coordinate information from the providers.  Clarify issues in the price adjustment request.

·      Clarify and evaluate the issues presented in the price adjustment request and make recommendations about additional funding.

·      Evaluate the surplus/loss analysis to ensure that the price adjustment is warranted.

 

Perform cost calculations.

 

·      Calculate on an annual basis cost rate percentages. 

·      Prepare an annual cost finding which identifies the total costs of operations and allocates allowable overhead and support costs into the appropriate final cost centers. 

·      Identify all direct costs for agency operations.

·      Utilize the costs established in the agency cost finding, and prepare an annual Medicaid cost report for programs by site.

 

Perform rate setting activities.

 

·      Develop/update inpatient Medicaid rates/fees for State agencies in accordance with applicable rules, regulations, and agency standards.  

·      Assist in the development of specialty/other rates/fees, as assigned.

·      Determine the approved funding level per full visit. 

·      Responsible for all rate setting functions related to the new and existing State agency venues. 

·      May calculate the impact of cost of living adjustments and/or trend adjustments. 

·      Review price adjustment requests and ensure that support staff log and acknowledge all requests.

·      Review price adjustment requests and make assignments based on complexity and current workload.

·      Ensure that price adjustment requests received are appropriate and eligible for review.

·      Approve and process price adjustments that are within the allowed threshold.

·      Process actual price adjustments and transmit to Medicaid Management Information System.

·      Bring price adjustment requests that have policy implications to the attention of the administration.

·      Process all fee setting and related fiscal activities in accordance with applicable rules, regulations, and agency standards.

·      Responsible for all rate setting functions.

 

Perform provider relations.

 

·      Manage cost allocation, rate setting, and other case management financial support with budget and financial management, treatment, field office, local provider, and/or county staff.

·      Develop analysis of Medicaid and/or Medicare recipient level data to assist counties in the identification of potential recipients.

·      Provide timely and effective technical assistance to provider agencies relative to CFR compliance issues.

·      Provide technical assistance to clinics on fiscal issues.

·      Serve as liaison with other State agencies to resolve allowable cost issues and keep abreast of new developments that may impact the cost verification process.

 

Supervise subordinate staff.

 

·      Provide supervision, guidance, and oversight to subordinate staff, and intervene and resolve problems as necessary.

·      Determine and oversee staff assignments. 

·      Approve leave and track time and attendance.

·      Review, monitor, and evaluate staff performance. 

·      Complete performance evaluations.

·      Identify training needs and arrange for provision of training.

·      Manage and direct program activities by setting priorities and deadlines.

 

PRINCIPAL HEALTH CARE FISCAL ANALYST

 

May perform all of the same duties and functions as a Senior Health Care Fiscal Analyst and/or Associate Health Care Fiscal Analyst.

 

Perform program oversight.

 

·      Supervise the monitoring of provider revenues and related systems.

·      Develop and issue standard monthly revenue reports and ad hoc reports on revenues to staff.

·      Assure that the risk-based system for monitoring and managing reviews is developed and maintained effectively.

·      Develop and maintain criteria for the measurement of successful revenue generation.

·      Provide direct supervision to professional and lower level staff members.

·      Coordinate the review and approval process of State operated OPTS proposals.

·      Develop and implement the process for submitting an OPTS application for a State Operated Program.

·      Coordinate with other Central Office Bureaus the system enhancements required to implement OPTS for the State sector.

·      Serve as the Central Office liaison for all State OPTS proposals.

·      Facilitate review meetings.

·      Prepare and transmit to senior management the reports documenting performed reviews.

·      Coordinate and oversee the administration of the Consolidated Fiscal Reporting System (CFRS).

·      Oversee the maintenance and use of the Service Provider Expenditure and Revenue System (SPEARS).

·      Plan, coordinate, and oversee the setting and/or maintenance of Medicaid and/or Medicare, and other reimbursement rates/fees.

·      Plan, coordinate, and oversee the development and implementation of new econometric cost models and Medicaid fees.

·      Manage financial analysis activities of the bureau, unit, division, department, or team.

·      Develop and maintain policies and procedures for related operations.

 

Provide technical assistance.

 

·      Provide technical assistance to agencies and outside parties.

·      Resolve issues relating to the approval of a State OPTS proposal.

·      Resolve health care provider rate appeals.

 

Perform audits and/or studies.

 

·      Manage cost allocation, rate setting, and other case management financial support with budget and financial management, treatment, field office, local provider, and county staff.

·      Develop analysis of Medicaid and/or Medicare recipient level data to assist counties in the identification of potential recipients.

·      Work with field office, budget and financial management staff and local providers and counties to support initiatives.

·      Develop initiatives through collaboration with State agency staffs, local providers, and local governmental unit staffs.

·      Develop program/revenue guidelines and criteria for budget/revenue initiatives as well as analytical data on expected outcome of initiative.

·      Establish reimbursement methodologies.

·      Develop procedures and implementation plans.

·      Develop required reports and analysis.

·      Develop criteria for measurement of initiative success.

·      Work with budget and financial management, treatment, field office staff and counties to support initiative.

·      May identify and code all capital costs by fiscal year. 

·      Analyze, evaluate, and implement alternative service financing mechanisms.

·      Manage the analysis of demographic and service-related data as it impacts on the financial status of facilities and the communities they serve. 

 

Manage the cost finding/cost allocation process.

 

·      May oversee the development and maintenance of databases and data exchanges within and for an agency and their affiliates.

·      Administer the financial review component of grant review.

·      Review budgets and financial forecasts to ensure compliance with legislative intent and assess reasonableness of attaining goals/targets.

 

May serve as liaison with other Department bureaus and develop proposals for executive management action.

 

·      Perform and oversee analysis of large data sets using an appropriate computer software program and present findings in either a written or graphics format.

 

Represent the agency/department/unit at meetings.

 

·      Review budgets and financial forecasts to ensure compliance with legislative intent, and assess reasonableness of attaining stated goals/targets.

·      Coordinate financial analysis of proposals with staff to ensure that need projections (volume and occupancy) are reasonably reflected in proposed budgets.

·      Serve as liaison between the agency and the Division of the Budget (DOB).

 


CHIEF HEALTH CARE FISCAL ANALYST

 

May perform all of the same duties and functions as a Senior Health Care Fiscal Analyst, Associate Health Care Fiscal Analyst, and/or Principal Health Care Fiscal Analyst.

 

·      Plan, assign, supervise, and evaluate the work of a group of subordinate analysts performing a wide range of specialized activities related to the calculation and maintenance of Medicaid reimbursement rates.

·      Manage analysis and related activities.

·      Meet with and represent the agency/department/unit with other State agencies, outside consultants, applicants, and other interested parties.

·      Assist with activities related to the calculation and maintenance of Medicaid reimbursement rate issues.

·      Analyze the more complex rate setting requests.

·      Make final determinations on new position and reclassification requests not involving deviations from policy.

·      Discuss rate setting and procedural problems with the supervisory staff and assist them in the formulation of policy and the day-to-day management.

·      Train and develop staff to assure their technical competency and prepare them for potential advancement.

 


MINIMUM QUALIFICATIONS

 

SENIOR HEALTH CARE FISCAL ANALYST

 

Promotion:  successful completion of the Health Care Fiscal Analyst traineeship.

 

ASSOCIATE HEALTH CARE FISCAL ANALYST

 

Promotion:  one year of service as a Senior Health Care Fiscal Analyst.

 

PRINCIPAL HEALTH CARE FISCAL ANALYST

 

Promotion:  one year of service as an Associate Health Care Fiscal Analyst.

 

CHIEF HEALTH CARE FISCAL ANALYST

 

Promotion:  one year of service as a Principal Health Care Fiscal Analyst.

 

Date:  3/09

 

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.