Manager 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, reimbursement, and provider-related issues. Collaborates with providers, DODD representatives, Service Coordination, and agency leadership to address operational concerns and implement corrective actions when warranted. Reviews and approves changes related to congregate service sites and other authorization-related activities requiring management oversight

5. Training, Systems Support & Continuous Improvement (10%)

Provides training, guidance, and technical support to FCBDD staff, providers, and other stakeholders regarding waiver authorization, billing, and reimbursement systems. Monitors changes in regulations, reimbursement methodologies, and technology platforms and leads implementation efforts to ensure operational readiness. Evaluates existing workflows, identifies opportunities for improvement, and implements process enhancements that increase efficiency, strengthen internal controls, improve service quality, and support organizational goals. Performs other related duties as assigned.

Perform other related duties as assigned.

MINIMUM QUALIFICATIONS (REQUIRED)

· Bachelor's degree in Accounting, Finance, Business Administration, Public Administration, Human Services, or a related field.

· Five (5) years of progressively responsible experience in Medicaid waiver administration, billing, reimbursement, financial operations, or a related field, including supervisory experience.

· Demonstrated ability to manage staff, complex operational processes, budgets, and multiple priorities.

· Strong analytical, problem-solving, organizational, and communication skills.

· Proficiency with Microsoft Office applications and business information systems.

· Ability to meet all employment requirements, including successful completion of background and drug screening.

PREFERRED QUALIFICATIONS

· Extensive knowledge of Ohio Department of Developmental Disabilities (DODD) waiver programs, authorization processes, and reimbursement systems.

· Experience using DODD systems, including CPT, PAWS, MRC, MBS, AAI, LOC, ODDP, PSM, Tableau, or similar applications.

· Experience with Gatekeeper or comparable authorization and claims management software.

· Knowledge of developmental disabilities services, Medicaid funding, and county board operations.

Compensation and Benefits

This position contributes to the Ohio Public Employees Retirement System (OPERS).

Benefits of working at the Franklin County Board of Developmental Disabilities include:

• Tuition reimbursement
• On-site fitness
• Generous health care package including health, vision, dental, and life insurance
• Childcare assistance
• 14% employer contribution toward retirement plan
  ( or )
• Deferred compensation options
  ( and )
• Paid holidays
• Excellent leave policies including sick, vacation, and personal days