GENERAL SUMMARY OF POSITION:
This individual will report to the Program Manager for the Enhanced Coordination of Benefits Program under the Center for Health Care Financing (CHCF) TPL/Benefit Coordination Department. The ECOB Client Manager will serve as a quality assurance guarantor for the program’s benefit coordination activities in Hospitals and the CCM program. This position will also serve as a resource to the Center’s staff in matters concerning Enhanced Coordination of Benefits and any other issues as assigned by Center staff. This individual will ensure the integrity of the program by overseeing Insurance Program Coordinators residing at Hospitals throughout the state, to guarantee that proper coordination of benefits is being provided in accordance with program goals and Massachusetts state regulations.Responsibilities
- Responsible for overseeing Insurance Program Coordinators at assigned Hospital sites.
- Perform supervisory functions of hiring, training, corrective action and employee performance evaluation.
- Maintain that benefit coordination activities are documented appropriately by Insurance Program Coordinators and that all reported cost savings is justified.
- Attend meetings and prepare presentations at assigned Hospital sites, provide training sessions for hospital staff and outreach to hospital clinical services that would benefit from the ECOB program.
- Assist Insurance Coordinators in troubleshooting complex case coordination and provide direction for case referral initiatives.
- Make recommendations for and supervise implementation of improvements to program operations.
- Monitor staff adherence to policy and procedure standards.
- Review and analyze data concerning assigned projects in order to determine progress and effectiveness and make recommendations for changes in procedures.
- Perform related duties such as attending staff meetings, maintaining records and preparing reports.
- Analyze financial information from Hospitals.
- Manage special projects and other activities related to program development within defined timelines as assigned.
- Assemble appropriate staff to project teams to support department goals.
- Keep abreast of current and developing trends in health care administration in order to guide and advise staff and providers regarding policy changes that affect members.
- Represent the department and interact with Providers, Carriers, Employers, EOHHS and other government agencies.
- Performs other job related duties as required.
- Bachelor’s degree in management, Health Care, Business Administration, or equivalent experience.
- 5 years’ experience in management and/or project management.
- Strong written and verbal communication skills to interact effectively with staff, clients, and vendor staff.
- Thorough understanding of Third Party Liability/ERISA federal and state regulations associated with the Title XIX Medicaid program and/or cost avoidance.
- Demonstrated leadership ability in motivating a large group of people with diverse backgrounds to achieve a complex set of goals.
- Proficient in state MMIS and MA-21 Database for recipient and provider information and payment history.
- Strong computer skills, including word processing, spreadsheet, and PowerPoint.
- Ability to travel to off-site locations.