|
MCHCP
Departments
Executive
This department includes the Executive Director and the
Assistant Executive Director.
The management of MCHCP is
the responsibility of the Executive Director who is
appointed by the Board and serves at its pleasure. The
Executive Director acts as advisor to the Board on all
matters pertaining to the Plan and, with the approval
of the Board, contracts for professional services and
employs the staff needed to operate the Plan.
The Assistant Director is responsible
for maintaining knowledge of health care trends and
how they may impact on the MCHCP; coordinating the development,
evaluation and award of Requests for Proposal (RFPs)
and new products; assists in the negotiation and execution
of contracts; follows applicable new state and federal
regulations to ensure MCHCP’s compliance; and
assists the Director in daily management of the organization. |
Clinical
Review
Clinical review assists in the development and evaluation/analysis
of Requests for proposals (RFPs) for health plan vendors.
Oversees and evaluates performance of HMO, PPO and PBM
vendors who are awarded contracts by MCHCP. Monitors and
evaluates various provider issues including network development
by contractors, provider turnover and provider performance.
Serves as a liaison between members and contractors on
a wide range of medical situations and the interpretation
of benefits.
|
General
Counsel
Provides legal advice, opinions, and assistance to the
Board and the administration. Represents MCHCP, or coordinates
representation through outside counsel, in litigation
matters, including appeals. Assists in preparing and interpreting
legal documents (RFPs, contract amendments, etc.), and
is responsible for reviewing all contracts, proposals,
and communication material to be distributed to members
and others. Researches benefit related, contractual, and
legal compliance issues. Drafts proposed legislation and
analyzes current and pending federal and state legislation,
develops regulations, and provides assistance and advice
on the legality of policies. Also serves as MCHCP’s
Privacy Officer to ensure compliance with HIPAA.
|
Research
and Compliance
The Research & Compliance section is responsible for
the collection, analysis and reporting of various statistical
health related data. The section assists in development
and evaluation of Requests for Proposals (RFPs) for all
health plan vendors, and assists in projecting future
health plan trends and costs. The section evaluates and
monitors HMO, PPO and PBM vendors who are awarded contracts
by MCHCP; and maintains data on network development, provider
turnover and other factors affecting performance of the
contractors. This section also follows state and federal
legislation that may affect MCHCP and its members. Research
and Compliance is also responsible for conducting audits,
performing customer satisfaction surveys and serving as
a patient advocate when necessary.
|
Human
Resources
The Human Resources section is responsible for directing
all aspects of the MCHCP personnel program. These responsibilities
include interviewing and selection of employees, establishing
and maintaining a fair compensation system, conducting
new employee orientations and handling other employment
and staffing related issues. The Human Resources section
also writes and maintains job descriptions in a position
classification plan, handles wage and hour issues, worker’s
compensation reporting, training and development of workforce,
and writes and interprets personnel policies and procedures
while ensuring compliance with all federal, state and
local personnel laws. These functions are performed to
ensure fair and equitable treatment of all employees as
well as those candidates seeking employment. |
Fiscal
Affairs
The Fiscal Affairs section is responsible for all financial
records of the programs administered by MCHCP, including
preparation of the Comprehensive Annual Financial Report
(CAFR). Fiscal Affairs performs all purchasing functions
for MCHCP, coordinates banking services, interfaces with
the Office of Administration, accounting and budgeting
departments, various payroll/personnel officers of state
departments, accounting offices of health maintenance
organizations, consultants, actuaries, banks and the IRS.
The Fiscal Affairs section is staffed by six individuals
with specialties in Accounting and Business Administration.
|
Marketing
The Marketing section is responsible for informing and
communicating with Missouri local governments about the
health insurance plans available through the MCHCP. Staff
provides numerous opportunities for eligible local governments
to consider participating in the plans offered through
the MCHCP. These opportunities include but are not limited
to personal meetings, printed materials, audio and visual
presentations. MCHCP also uses the services of contracted
brokers who are trained by the marketing staff. There
are currently five people in this section who are specialists
in marketing, health insurance, risk management and administration.
|
Customer
Support
Customer Support is divided into two sections - Customer
Relations and Communications. Customer Relations is comprised
of eight Benefit Specialists, a receptionist and their
supervisor. This section is responsible for resolving
problems and answering questions regarding benefits and
eligibility for members of MCHCP. The Communications section
consists of four Communications Specialists, a Communications
Analyst, two Communications Assistants and a Graphic Designer.
Communications is responsible for educational and informational
materials provided to members. This section conducts educational
meetings throughout the state for open enrollment, new
employee orientation, active employee and pre-retirement
seminars and payroll/personnel workshops. Communications
Specialists also function as account representatives to
the individual state agencies and participating public
entities. This section serves as a liaison between members,
payroll/personnel representatives and the contracted insurance
providers for MCHCP. Ultimately, Customer Support is responsible
for customer service and customer satisfaction. |
Membership
Services
The Membership Services section is staffed by 11 membership
technicians, two quality control specialists, one membership
clerk and a supervisor. This section is responsible for
maintaining all enrollment records for eligible members
and for any changes to their coverage. They also administer
coverage for retirees, survivors, members on leave-of-absence,
those eligible for long-term disability, vested members
who leave employment and COBRA coverage under Federal
guidelines. The section is also responsible for insuring
that public entity contributions, state contributions
and member contributions are appropriately applied to
members’ accounts. Also included is the Receiving
Services section, consisting of three document technicians
and a supervisor. This section is responsible for all
mail room activities, shipping and receiving, and minor
building maintenance and repairs.
|
Data Management Systems
The Data Management Systems section is responsible for
the collection, processing, and dissemination of all
electronic based information for the MCHCP. It is the
responsibility of this section to provide the system
hardware and software necessary to accomplish these
objectives in a timely, accurate, and cost effective
manner. Additionally, our staff provides ongoing custom
application development and support for every level
of agency operations and business processes. The proliferation
of systems and applications based on Internet technologies
now plays a key role in our daily operations and will
influence strategic planning for the foreseeable future.
This strategy will provide for ever increasing system
standardization, integration, and efficiency, while
allowing current system investments to be leveraged
for future technology and business processes. We look
forward to the challenges ahead as we endeavor to provide
world class technologies and support.
|
|
|
|
Home
