Division of Operations Management
The Division of Operations Management
is headed by Deputy Commissioner Vacant. This division is responsible for all Information Technology initiatives within the Bureau, including the oversight of the Office of Technology and Reporting, Office of Program Integrity, the Quality unit as well as leading the Bureaus’ Personnel, Medicaid Information Technology Architecture (MITA), and working with the DHHR Office of Management Information Services.
- 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.
- The Office of 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 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. Marcia R. Clark, RN leads the MITA team.
- The Quality Unit incorporates sustainable quality assurance and quality improvement principles in the planning, design, delivery, and evaluation of support and services; standardizes the collection, reporting, and monitoring of data, processes, and quality measures in order to support and drive decisions; and develops and implements quality management strategies that support the achievement of positive outcomes for the West Virginia Bureau for Medical Services. Marcia R. Clark, RN 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.
- The Medicaid Management Information System (MMIS) is managed by the Department of Health and Human Resources Office of Management information Services. The 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.