Manger of Waiver Authorizations

POSITION SUMMARY Provides leadership and oversight for the authorization, billing, reconciliation, and financial management functions associated with Medicaid waiver and non-waiver services.

The Manager of Waiver Authorizations ensures compliance with DODD requirements, maintains the integrity of waiver payment systems, supervises departmental staff, and supports FCBDD's mission through efficient and person-centered service authorization processes.

Responsibilities include operational leadership, budget oversight, quality assurance, staff development, and continuous process improvement.

ESSENTIAL DUTIES AND RESPONSIBILITIES 1.

Waiver Authorization & Billing Administration (35%) Provides leadership and oversight of all waiver authorization and billing activities to ensure accurate, timely, and compliant service authorization processes.

Directs departmental operations related to entry and maintenance of authorization data within DODD systems, including CPT and other applicable platforms.

Ensures authorization transactions are processed within established timeframes and oversees Medicaid Targeted Case Management billing, reimbursement activities, and third-party payer billing for non-waiver services.

Maintains overall responsibility for the integrity of authorization processes and related fiscal activities.

2.

Financial Reconciliation & Budget Management (25%) Manages the department's financial reconciliation and budget monitoring functions, including oversight of paid and billed claims reconciliation, identification and correction of discrepancies, and resubmission of claims as necessary.

Directs the import and analysis of Medicaid claims data and ensures accurate tracking of waiver expenditures.

Maintains Self Waiver budgets and cost projection tools and reviews Individual Options Waiver expenditures to identify situations requiring prior authorization or fiscal intervention.

Oversees the maintenance and updating of budget resources used by Service Coordination staff to ensure compliance with funding requirements and reimbursement regulations 3.

Leadership, Supervision & Staff Development (20%) Provides direct supervision, leadership, and development of assigned staff.

Plans, organizes, directs, and evaluates departmental operations and resources to ensure effective service delivery and achievement of organizational goals.

Establishes performance expectations, promotes accountability, supports professional development, and fosters a collaborative work environment that reflects FCBDD's commitment to person-centered services, continuous improvement, and operational excellence 4.

Compliance, Quality Assurance & Problem Resolution (10%) Ensures departmental compliance with applicable federal, state, county, and agency regulations governing waiver authorizations, billing, and reimbursement processes.

Reviews authorization and billing activities to maintain system integrity and accuracy and serves as a resource for resolving complex payment, reimburs...