Occ. Code 0232130

CONTRACT MANAGEMENT SPECIALIST 1 (HEALTH BENEFIT EXCHANGE), GRADE 18	0232130
CONTRACT MANAGEMENT SPECIALIST 2 (HEALTH BENEFIT EXCHANGE), GRADE 23	0232230
CONTRACT MANAGEMENT SPECIALIST 3 (HEALTH BENEFIT EXCHANGE), GRADE 27	0232330
CONTRACT MANAGEMENT SPECIALIST 4 (HEALTH BENEFIT EXCHANGE), M-4	0232430

New York State Department of Civil Service

Classification Standard

BRIEF DESCRIPTION OF CLASS SERIES

Contract Management Specialists (CMS) (Health Benefit Exchange) (HBE), manage health and dental plans (health plans) offered through the Individual Marketplace Qualified Health Plans and Essential Plans, and the Small Business Marketplace (SHOP), from original solicitation of plans, through implementation, plan performance evaluation, and operations. The Marketplace is a centralized location where consumers shop among approved plans, apply for enrollment, and access federal financial assistance in accordance with the federal Affordable Care Act.

The Marketplace is developed and maintained by the Department of Healths New York State of Health (NYSOH), also referred to as the Exchange, and authorized by Governor Cuomos Executive Order #42 issued in April 2012.

Distinguishing Characteristics

CONTRACT MANAGEMENT SPECIALIST 1 (HBE): full performance level; under the direction of higher-level CMS (HBE), may be assigned to the individual or the Small Business Marketplace; evaluates or reviews assigned health plan contracts per standards set forth in the federal Affordable Care Act and NYS Executive Order #42, issued April 2012, for participation in the Marketplace.

CONTRACT MANAGEMENT SPECIALIST 2 (HBE): advanced performance and/or first supervisory level; reports to a CMS 3 (HBE); and may be assigned to the individual or the Small Business Marketplace; serves as part of a team charged with certifying health plans for participation in NYSOH, manages all aspects of the relationship with specific marketplace health plans participating in NYSOH; and serves as a subject matter expert in the design, testing, implementation, and refinement of Marketplace operations as they relate to health plan offerings. May supervise CMS 1 (HBE) and paraprofessional staff.

CONTRACT MANAGEMENT SPECIALIST 3 (HBE): managerial level; reports to the CMS 4 (HBE); may be assigned to the individual or the Small Business Marketplace; manages a team of professional staff charged with certifying health plans for participation in NYSOH; manages all aspects of the relationship with marketplace health plans participating in NYSOH; and works with the CMS 4 (HBE) and other departments to develop and implement strategies that align with the goals of the Marketplace.

CONTRACT MANAGEMENT SPECIALIST 4 (HBE): one position class; director level; designs, develops, and issues health plan participation solicitations and directs staff engaged in all aspects of the relationship with Qualified Health Plans and Essential Plans that participate in NYSOH.

Illustrative Duties

CONTRACT MANAGEMENT SPECIALIST 1 (HBE)

Utilizes knowledge of the health plans and benefits offered on the Marketplace to assist applicants and answer questions.

Assists in developing annual solicitations for health plan applications for participation on the Marketplace, including gathering data to create exhibits and tables.

Assists in the review of applications submitted by health plans applying for acceptance as Qualified Health Plans; ensure proposals are complete and in compliance with requirements.

Gathers data from evaluations, metrics, and consumer satisfaction to provide summary reports for supervisors.

May perform many of the duties of the CMS 2 (HBE) under close supervision to assist the CMS 2 (HBE) with ongoing maintenance of contracts and health plans by evaluating health plan compliance, performance metrics, and consumer satisfaction.

CONTRACT MANAGEMENT SPECIALIST 2 (HBE)

Reviews applications requesting acceptance as certified Marketplace health plans to verify programmatic correctness, adherence to federal and State policy, compatibility with NYSOH goals, and health plan solicitation requirements.

Ensures Marketplace health plans comply with the certification standards contained in federal regulations at 45 CFR[1] 156, including standards relating to licensure, service area, network adequacy, essential community providers, marketing, and benefit design.

Ensures Marketplace health plans meet actuarial value and essential health benefit standards in accordance with applicable regulations and guidance.

Ensures cost-sharing limitations are in place for each plan.

Reviews plans to ensure standard plans are being offered at each level, when required; and verifies that non-standard plans adhere to actuarial value, essential benefit, and solicitation requirements.

Works with health plans to ensure that all participation requirements are met and there is adequate participation in both the individual and Small Business Health Plan Marketplace.

Monitors Marketplace health plans for evidence of ongoing compliance with certification requirements, as well as compliance with NYSOH processes, procedures, requirements, and interfaces.

Collaborates with staff at the Department of Financial Services on issues related to regulatory compliance and to ensure the accuracy of information available to consumers through the website, member subscriber agreements, handbooks, and plan comparisons.

As a subject matter expert:

· Defines programmatic business rules related to health insurance coverage to be used in the development, testing, implementation, and refinement of information technology systems, including the Marketplace website and information exchange with health plans participating in the Marketplace.

· Develops, vets, and implements protocols and standards to ensure that health plan provider networks are current, accurate, and meet adequacy standards; resolves deficiencies as they arise; serves as subject matter expert on the design or redesign of information technology systems to collect, report, and display provider affiliations with health plans.

· Develops training curriculum and resources for customer service representatives, in-person assistors, and staff on the health plans and benefit variations offered on the Marketplace, provider network comparisons, cost-sharing variations, and premium comparisons.

May supervise subordinate staff.

CONTRACT MANAGEMENT SPECIALIST 3 (HBE)

May perform any of the duties of a Contract Management Specialist 2 (HBE).

Directs and manages a team of professional staff responsible for assigned portfolios that typically consist of four insurance companies certified to offer Qualified Health Plans on the Marketplace. Manages a portfolio of insurers offering the Essential Plan, a health insurance option with four variations for lower-income New Yorkers, and dental insurers that offer stand-alone dental coverage.

Assists in developing criteria for certification of Marketplace health plans consistent with Federal and State law and to achieve the goals of NYSOH to ensure that individuals and small businesses have access to affordable, comprehensive, health insurance coverage. Makes recommendations regarding health plan certification to senior management.

Works in close collaboration with the Department of Financial Services to develop and implement strategies, policies, and procedures to certify health plans for participation in the Marketplace with the goal of maximizing efficiency, streamlining the application process, making comparison of plan options easier for consumers, and ensuring consistency with the States outside insurance markets and the goals of the Marketplace.

Works with the NYS Department of Healths Office of Quality and Patient Safety to design and implement quality and consumer satisfaction measures for use in selecting a Marketplace health plan, to improve overall performance of Marketplace health plans, and for making recommendations about health plan Marketplace certification decisions.

CONTRACT MANAGEMENT SPECIALIST 4 (HBE)

In collaboration with the NYSOH management and senior staff of the Department of Financial Services, develops purchasing strategies to ensure that individuals and small businesses that purchase coverage through NYSOH have access to affordable, comprehensive health insurance coverage.

Develops requirements and criteria for certification of Qualified Health Plans and Essential Plans consistent with federal law, rule, and guidance, and to achieve the goals of NYSOH; and makes recommendations regarding health plan certification to senior management.

Collaborates with the Department of Financial Services to develop and oversee staff in the administration of a process to certify health plans for participation in NYSOH.

Serves as liaison with senior staff at the Department of Financial Services on issues related to regulatory compliance, premium rate approval for Qualified Health Plans, and the risk-adjustment and reinsurance requirements of federal law.

Directs and manages the Division of Plan Management, including the on-going identification and resolution of a wide range of policy and operational issues, with Qualified Health Plans, and Essential Plans participating in NYSOH.

Works with the Department of Health, Office of Quality and Patient Safety, to develop and oversee strategies to measure and improve performance of participating health plans.

Serves as subject matter expert in the development and on-going operations of the NYSOH information technology systems as they relate to the accuracy of participating health plan information, consumer selection of health plan options, electronic data exchange with participating health plans, and the health plan provider network directory system.

Represents the Executive Director with federal authorities, NYS legislators, and NYS control agencies.

Minimum Qualifications

CONTRACT MANAGEMENT SPECIALIST 1 (HBE)

Open-Competitive: Bachelors degree in Accounting, Business Administration, Economics, Finance, Health Administration, Public Policy, Heath Policy, Health Systems, Health Care Management, Public Administration, or Political Science, and two years of professional experience in the direct administration of private or public health insurance,* or service coordination for public health insurance-eligible consumers within a state-regulated facility, or completion of two-year traineeship for CMS 1 (HBE).

CONTRACT MANAGEMENT SPECIALIST 2 (HBE)

Open-Competitive: seven years of professional experience in the direct administration of private or public health insurance* or service coordination for public health insurance-eligible consumers within a state-regulated facility.

Promotion: one year as a Contract Management Specialist 1 (HBE).

CONTRACT MANAGEMENT SPECIALIST 3 (HBE)

Open-Competitive: nine years of professional experience in the direct administration of private or public health insurance* or service coordination for public health insurance-eligible consumers within a state-regulated facility; two years of the experience must have been at a supervisory level.

Promotion: one year as Contract Management Specialist 2 (HBE).

CONTRACT MANAGEMENT SPECIALIST 4 (HBE)

Open-Competitive: eleven years of professional experience in the direct administration of private or public health insurance* or service coordination for public health insurance-eligible consumers within a state-regulated facility; two years of the experience must have been at a managerial level.

Promotion: one year as Contract Management Specialist 3 (HBE).

*The professional experience in the direct administration of private or public health insurance may have included public or private health insurance exchanges, health insurance plans, regulatory compliance, benefit design and administration, provider relations, and/or financial reporting and analysis.

Substitution: a bachelors degree in a field listed under CMS 1 (HBE) may substitute for four years of the described professional experience. A masters degree in one of these fields may substitute for one additional year of the described professional experience.

* Examples of qualifying health facilities and programs include hospitals, nursing homes, adult homes, ambulatory care facilities, managed care organizations, psychiatric centers, developmental centers, diagnostic and treatment centers, home health care agencies, assisted living facilities, alcoholism and substance abuse treatment facilities, and community based agencies that serve the developmentally disabled. Experience as a private practitioner or in a physicians office is NOT considered qualifying.

Date: 5/18

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