GENERAL SUMMARY OF POSITION: 

Under the general direction of the Director or designee, the Associate Program Director is responsible for the management and oversight of program operations, including case management, eligibility determination, payment operations, client services, program integrity and continuous quality improvement.  This position is also responsible for indirect oversight of financial operations, contract management, program development, information technology and business analytics, project management, state and federal policy, and client relations.

PPR unit at HCFS works closely with state health and human agencies and municipalities to enhance their ability to improve their federal claiming processes, find new revenue opportunities, and coordinate with other payers to capture revenue whenever possible. With a deep knowledge of federal Medicaid regulations, PPR maximizes opportunities, while ensuring compliance with all applicable state and federal rules.  PPR provides its clients with comprehensive medical billing and accounts receivable, as well as other services, to maximize the collection of federal, third-party, and private reimbursement for health care and related services provided by public hospitals, mental health clinics, psychiatric hospitals, skilled nursing facilities, and community-based programs.  Community-based services include Home and Community-based Waivers, Residential Rehabilitation Option and Targeted Case Management programs.  The program produces over $2 billion in gross charges to liable payers and generates over $1.2 million in net revenue. 

MAJOR RESPONSIBILITIES:

• Direct and oversee program activities across business units and report program updates and changes to EOHHS and state agencies; .ensure that program deliverables and related activities are prepared and submitted as required in a timely manner; ensure that due dates related to program activities are met.
• Manage information technology activities, ensuring staff has access to required systems to perform services and meet system requirements, and problems related to program activities are reported and resolved.
• Apply expertise to direct the development of system initiatives, including business requirements; identify opportunities for system enhancements.
• Manage program operations and related activities, which may include payment rate setting, eligibility determination, benefit recovery including recoupment of overpayments, insurance identification, validation and management, claims preparation and submission, accounts receivable management, revenue forecasting, statistical reporting, administrative claiming information system troubleshooting, and program integrity.
• Oversee quality management services including project management, process development and improvement activities across business units to enhance operational efficiencies; monitor business processes to implement efficiencies and quality enhancements to service delivery as opportunities arise.
• Apply expertise to identify and direct the development of new CHCF and program initiatives, both in state and out of state; consult with clients and potential clients on exploring new initiatives.
• Resolve program issues that may impede successful fulfillment of contract requirements or program deliverables.
• Collaborate with the staff of the CHCF, EOHHS, state agencies and other organizations to improve client partnerships, business services and operations.
• Research all regulatory changes that impact program operations to identify and necessary programmatic changes to meet these new requirements.
• Oversee program development activities that enhance organizational and staff development.
• Prepare and monitor program budget.
• Interview, hire, train, supervise and evaluate staff.
• Assist in the oversight and development of contracts.
• Write, review and maintain business documents including reports, contracts, manuals, procedures and presentations.
• Participate in and implement continuous quality improvement initiatives.
• Foster compliance with state and federal rules and regulations.
• Preserve confidential information and files.
• Fulfill additional duties as required or requested.

REQUIRED QUALIFICATIONS:

• Master’s degree in Finance, Business, Public or Health Care Administration or related field, or equivalent managerial experience
• 10 years of solid experience and proven skills in financial management or operational management
• Proven administrative and management ability in complex environments and vast operational areas
• Strong management, leadership, team building and customer service skills
• Demonstrated experience working with multiple public sector entities
• Superior oral and written communications skills and strong public speaking ability
• Demonstrated performance in finance, program development or program implementation
• Thorough knowledge of funding and revenue sources for health and human services programs
• Thorough knowledge of federal and state rules and regulations related to health and human services programs

PREFERRED QUALIFICATIONS:

• Excellent analytical skills and independent judgment
• Demonstrated ability to simultaneously work numerous projects and meet deadlines, while maintaining daily business continuity and service responsibilities
• Ability to clearly and concisely synthesize relevant and key information that impacts business operations
• Knowledge of federal and/or state health and human service programs and information systems such as the Medicaid Management Information System (MMIS), BEACON, MA21 or the Massachusetts Management Accounting and Reporting System (MMARS)
• Experience or familiarity with social security data and federal data files, particularly SDX, SVES, or Bendex Expertise in business process flow development
• Successful experience leading program development initiatives
• Experience in business requirements development, preferably using an Agile project management methodology
• Lean certification or experience working with Lean principles
• Ability to perform work with a sense of urgency

The University of Massachusetts Medical School’s Commonwealth Medicine division offers a unique combination of academic excellence and public service expertise. Our programs have helped Massachusetts and many other state and local agencies increase the value and quality of public expenditures, and improve access and delivery of care to at-risk and uninsured populations.  As a public organization, we are uniquely prepared to meet the challenges of state and local agencies, and fulfill our vision of providing underserved populations access to quality services.

Public agencies often have many opportunities to increase their funding alternatives, but need to enhance resources to pursue the additional revenue. The Center for Health Care Financing (CHCF) helps state and local governments to identify opportunities for revenue enhancement and public service delivery, establish effective programs and capitalize on all possible revenue streams. At the same time, we identify opportunities for our clients to increase services and reduce the net cost of delivery.

Our services range from program analysis and consultation to hands-on program administration. Our consultants have an extensive understanding of government structures and are well versed in the most current developments in federal, state and local legislation and regulations.  Unlike most other consulting firms, we are public servants and we believe in “knowledge transfer.” As part of the Medical School, CHCF is dedicated to imparting our expertise in educating public agencies to help them ensure the long-term fiscal stability of their public health services. States implementing our innovative financing programs have realized substantially increased federal reimbursement.

Travel to other PPR sites in MA required.