Division of Operations Management
The Division of Operations Management
is headed by Deputy Commissioner Edward L. Dolly. This divison is responsible for all Information Technology initiatives within the Bureau, including the oversight of the Office of MMIS, Office of Technology and Reporting, Office of Quality and Program Integrity as well as leading the Bureaus’ Personnel, Medicaid Information Technology Architecture (MITA), and Project Management Sections. Currently, Deputy Commissioner Dolly also serves as the designated State Coordinator for Health Information Technology Initiatives.
- The Medicaid Management Information System (MMIS) manages the Bureau’s Medicaid Management Information System, a claims processing system that processes over 17 million claims annually which accounts for program expenditures in excess of $2.4 billion dollars. The Medicaid program enrolled over 405,000 members as of the end of SFY 2010 through a network of approximately 23,000 health care providers. Emily McCoy is the Director for the Office of MMIS.
- The Office of Technology and Reporting is responsible for the coordination, development and implementation of HIPAA Security and Continuity of Operations Methodologies, electronic work flow and collaboration initiatives, legacy application management and quality assurance and performance metrics for the Bureau. The Office also develops, implements and maintains BMS SharePoint and Internet sites, maintains all hardware and software for the Bureau and is responsible for implementation and maintenance of new technologies such as instant messaging and OCS phone systems, and will be responsible for all reporting within the DW/DSS once developed and implemented. Michelle A. Gafur is the Director for the Office of Technology and Reporting.
- The Office of Quality and Program Integrity completes the activities required under 42 CFR Section 456. This mandate requires post payment review of paid claims to assure that the services were provided by eligible providers to eligible clients, that the services were medically necessary, appropriate to the patient’s medical condition, and were provided in conformance with the service definitions set forth in the Medicaid manuals. This unit uses tools such as on-site reviews, desk reviews, and analysis of paid claims data to meet this mandate. Tammy Hypes directs this unit.
- The Project Management Office is responsible for the oversight, coordination and operations of Bureau specific portfolio and project management activities and initiatives. This includes planning and policy development support, as well as the collaboration with other defined project management groups within the Executive Branch, DHHR, other Agencies and vendors with respect to initiatives for the Bureau. Ed Dolly currently leads all project management initiatives.
- The Medicaid Information Technology Architecture (MITA) Office is responsible for the development, coordination and implementation of processes, procedures and initiatives related to MITA adoption within the Bureau. This Section was developed to support the CMS objective of an integrated business and information technology transformation in all states in order to improve how Medicaid operates across the Enterprise. Suzanne P. Lopez leads the MITA team.
- The Personnel Section is responsible for the coordination the Bureau’s Human Resources operations. This includes the support for employee Information, Payroll, Benefits Coordination, internal Policy, Procedures and attendance management. Kim D. Huffman manages all Personnel activities.