Provides supervisory oversight of staff responsible for the development, modifications, and interfaces of IT systems logic, data, and procedures designed to support the Medical Assistance programs.Serves as a liaison between Bureau of Data & Claims Managment, other program offices, contracted vendors, and other business partners for managed care related system issues and is involved in system enhancements/modifications required to support expanded managed care programs throughout the Commonwealth.Responsible for directing the continuing development of processes to support changes in the Medicaid Program systems. Reviews and evaluates contracts, Center for Medicare & Medicaid Services (CMS) waivers, and medical assistance policies in determining the need for changes or enhancements to processes.Ensures implementation of HIPAA regulations are consistent with requirements and meet program objectives related to MMIS processing and membership system. This includes the HIPAA 834 eligibly transaction requirements. Ensures the modifications to PROMISe™ meet the Medicaid program and Office of Medical Assistance Programs objectives.Participates in business requirement and system design sessions to define business rules and processes for system changes required by federal and state legislation and rules.Oversees the change management processes and submission of Business Requirement Documents (BRDs), Change Orders, and Defects for all MMIS system changes.Oversees the development and submission of defects and change requests for all BIS CIS/eCIS systems requirements and changes generated by the Bureau of Data and Claims Management in support of managed care membership and payment processes. This includes providing support and/or coordination of managed care components in programs under the Office of Mental Health and Substance Abuse Services (OMHSAS), the Office of Long-Term Living (OLTL), and the Office of CHIP (OOC).

Manages the development and implementation of new initiatives for the division impacting the Program Development Section, including DHS initiatives.Providing leadership, technical assistance, program guidance, policy development and TPL representation to the Office of Income Maintenance, County Assistance Offices, Office of Long Term Living, Office of Mental Health and Substance Abuse Services, and the Office of Medical Assistance Programs.Manages the development and monitoring of contracts for TPL- TPL data exchanges and recovery vendor and Medicare identification and enrollment. This includes development of new or revised statements of work, evaluation and analysis of proposals and manages day to day operations.Manages TPL involvement with OIM (Office of Income Maintenance) regarding TPL data on CIS (Client Information System). This includes system development, testing for online and batch processes and new Federal or State initiatives. This also includes providing guidance and critical decision making for a multi-year initiative to move TPL data from mainframe to open systems.Works in collaboration with other Dept staff and business partners to develop requirements for new MMIS( claims processing system), evaluate, provide guidance for all aspects of impacts on TPL.Manages the health insurance related post-payment recovery activities conducted by TPL to maximize the state and federal funds.Reviews and analyzes Federal and state laws and regulations and programs as relates to TPL functions and potential areas of recoveries which could lead to development of program policy or program improvements. Reviews, analyzes and evaluates Medical Assistance Program regulations and objectives related to the TPL program.Evaluates program initiatives to ensure compliance with Federal and State regulations.Analyzes financial reports, development of policy and procedures to ensure contract compliance and strategies.

Department of Human Services - Bureau of Program Integrity - Division of Third Party LiabilityDirectly supervises a staff of four(4)Human Services Program Specialists engaged in the review, analysis, development, and evaluation of TPL (Third Party Liability) program and Department wide initiatives to ensure the efficient operation of the program and to maintain compliance with federal regulations, and CIS TPL resource integrity.Plans, directs, organizes, assigns work and determines work priority and goals of professional staff.Responsible to coordinate, facilitate, develop, test, and communicate TPL initiatives/requirements/regulations with staff from the various areas: Office of Income Maintenance (OIM), Bureau of Information Systems, Deloitte Consulting, KPMG, Office of Long Term Living (OLTL), DXC Technology, Office of Medical Assistance programs (OMAP), Health Management Systems, University of Massachusetts Medical School and other entities.Responsible for all TPL activities related to the data stored and maintained on CIS. Duties include: 1) analyze and participate in requirement and design sessions with appropriate personnel to effectively update/revise/modify TPL software housed in CIS 2) test all TPL software 3)maintain the TPL insurance carrier codes listing, 4) initiate and submit change requests or defects 5) communicate all changes to TPL internal staff and issue daily status or provide input for Operations Memorandums to Income Maintenance staff 6) troubleshoots day to day TPL issuesProvides oversight to numerous data exchange activities and TPL reportsAssist and provide direction/guidance to TPL Contract Management and Application Management staff with all TPL resource issues from the MCOs, and supplemental data exchange contractor.Works with OMAP to evaluate/modify TPL data displayed on the Eligibility Verification Systems (EVS).

Department of Human Services - Bureau of Program Support - Division of Automation Planning & SupportThe main function of this position was to provide support in the development and maintenance of automated systems that support highly complex benefit entitlement programs administered by the Office of Income Maintenance, including Cash Assistance, SNAP, Medical Assistance, LIHEAP, and others. These automated systems have a critical impact on the program benefits for Pennsylvania citizens and are used by approximately 6,500 local county assistance office (CAO) workers at over 70 sites throughout the Commonwealth.The work performed in this position included interpretation of current and new regulations, analysis of business processes, and coordinating the development and maintenance of new or modified computer applications to support the efficient administration of OIM benefit programs. Work included ongoing information technology support through hands-on application testing, problem resolution, support for field staff, and the development of written procedures, forms, and operational announcements and instructions.