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HCFS Associate Program Director for Benefit Coordination & Recovery

Job Details

Overview

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 program  management, , client services, program integrity and continuous quality improvement.  This position is also responsible for contract management, program development, information technology and business analytics, project management and reporting, state and federal policy, and client relations.

 

This Associate Director position leads the Benefit Coordination and Recovery (BCR) Team in Third Party Liability (TPL) initiatives at Health Care Finance Solutions (HCFS).  BCR works with state Medicaid programs to identify and coordinate federal and state benefits for program recipients, helping ensure that individuals receive all benefits to which they are entitled, with a focus on private health insurance related benefits.  The Associate Director will lead the BCR Team in providing health insurance identification, benefit coordination and claims processing with private health insurance, recovery programs with Medicare and private insurance, data management and analytics, and programs for the Massachusetts Executive Office of Health and Human Services (EOHHS) and Medicaid (MassHealth) program, as well as potential out-of-state clients.  Areas of responsibility will include overseeing unit operations, management, and contract compliance; directing project and financial reporting, invoicing, and internal control processes; collaborating on IT development and maintenance activities; and leading new project and business development.

Responsibilities

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.
Qualifications

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:

  • 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), Health Insurance Exchange (HIX)  MA21,  or Medicare processing systems
  • Experience or familiarity with commercial insurer and Medicare payers and data  
  • Expertise in business process flow development
  • Successful experience leading program development initiatives
  • Experience with  analyzing data sets and data analysis, utilizing data to draw inferences and conclusions, and producing reports Project Management certification or experience working with project management tools
  • Experience with SQL and Microsoft Office products 
Additional Information

Health Care Finance Solutions (HCFS) is part of Commonwealth Medicine (CWM), a division of University of Massachusetts Medical School.  CWM programs combine academic excellence and public health service expertise to provide health care solutions ideal for the public sector and not-for profit organizations.  CWM has helped Massachusetts and many other state and local health care agencies increase the value and quality of health care expenditures and improve access and delivery of care to at-risk and uninsured populations. 

 

Located in Charlestown, MA, HCFS helps state agencies identify opportunities to increase savings and reimbursements through federal and other third-party sources, establish effective savings and reimbursement programs, and capitalize on all possible revenue streams. At the same time, we identify opportunities for our clients to increase health care related services, reduce the net cost of delivery, and help ensure individuals receive the health and human service benefits to which they may be entitled.

 

The Benefit Coordination and Recovery (BCR) team, within HCFS, is responsible for a wide mix of projects and initiatives that share a common link of coordinating Medicaid, Medicare and commercial insurance coverage for recipients of public health and human service benefits.  Using a data driven approach, the team is responsible for identifying, researching, developing, and implementing cost savings initiatives, through coordination of benefits on behalf of health and human service agencies.  Through each venture, the BCR team works to maximize benefits for recipients, while ensuring cost effectiveness for clients. 

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Organization

Realize Your Opportunities – A Career at UMASS Medical School

Inside Workings at UMASS Medical School

The University of Massachusetts Medical School (UMMS), the Commonwealth's only public medical school, is proud of our role in serving the people of Massachusetts. Although, its the inside workings of UMMS that makes the difference.

Mission and Culture

  • We’re serious about our mission and about our people. 
  • Real World Impact - Our people get excited about our mission of real-world impact in health sciences education, research and public service.
  • International Prominence and New Opportunities - As this institution has grown to national – and international – prominence, we’ve found new opportunities to train tomorrow’s physicians, nurses and scientists,  discover causes of and cures for disease and help improve the quality of health care.
  • Deep Commitment - With our clinical partner, UMass Memorial Health Care, and our other teaching affiliates, we share a deep commitment to national distinction in patient care.
  • Valued Partnerships – UMMS partners with Commonwealth Medicine, the health care consulting arm of UMMS. Also, UMMS partners with MassBiologics in scientific collaborations, technology management and creating partnerships for the development of products for the benefit of patients.  These valued partnerships help us to provide services and programs to help meet our needs at UMMS and the public.
  • Proud Contributors - People at UMMS enjoy the feeling of going to work every day knowing what they do is truly important and worthwhile.
  • Complementary and Inseparable - These varied parts of our mission and culture are complementary and inseparable.                 

Careers

UMMS, the state’s first and only public academic health sciences center, educates physicians, scientists and advanced practice nurses to heal, discover, teach and care, with compassion.  UMMS is a world-class institution with opportunities to match. 

Competitive Compensation – UMMS offers salaries that are competitive with Worcester-area employers. When combined with our generous benefits, perks, and paid time off, many job seekers are surprised to find a total rewards package that matches or exceeds their current situation.

Targeted Hiring Process – At UMMS, there are actually multiple hiring processes for different segments of our workforce.  In nearly all cases, UMMS hiring process is decentralized, with qualified candidates screened and referred to an academic officer or manager with hiring authority.

24/7 Access to Employment Opportunities – iCIMS is our online job search and application system.  iCIMS is available 24/7 to provide you with a convenient and up-to-date view of the available employment opportunities across our campuses. Updates are made daily and include all faculty and non-faculty position listings from every school and department within the UMMS. When you identify a position you are interested in and qualified for, apply online. New opportunities become available frequently so it pays to check back often!

Benefits

With outstanding benefits, competitive pay, extensive learning opportunities, and a stimulating and attractive work environment, UMMS may be exactly the employer you’ve been looking for.

• Superior Benefits - UMMS offers a wide range of benefits and perks that invite comparison with the best employers in the Worcester area – and with academic institutions anywhere. UMMS provides superior medical and dental coverage for you and your family, fully funded retirement plans, generous time off, a Tuition Assistance Plan – and much more.

• People Centered - UMMS is an employer, but it is also a community. Its comprehensive medical and dental benefits, retirement plans, and even paid holidays reflect an institution built around people, with a deep respect for their differences and needs.

• Commitment to Healthy Living - UMMS provides resources to help you balance work and life and encourages healthy living through great programs and discounts for fitness, physical activity, weight management, nutritional counseling and general wellness available through our health insurance plans.

• Breadth of Offerings - Above all, the breadth of UMMS offerings set the School apart and makes it an environment favored by all sorts of smart, career-savvy people.

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As an equal opportunity and affirmative action employer, UMMS recognizes the power of a diverse community and encourages applications from individuals with varied experiences, perspectives and backgrounds.

Online - To view all job opportunities and apply online, visit www.umassmed.edu/hr and click on the “Careers” tab.

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A History of Making Vital Improvements - UMASS Medical School Milestones

1962: Legislation establishes University of Massachusetts Medical School
1970: First medical students begin classes in Shaw Building
1974: First class graduates 16 MDs
1979: PhD program begins
1986: Graduate School of Nursing opens
1986: PhD program becomes Graduate School of Biomedical Sciences
1994: Graduate School of Nursing initiates PhD program
1998: UMass Clinical System and Memorial Health Care merge to form UMass Memorial Health Care
2001: Lazare Research Building opens
2002: Campus Modernization begins on the University Campus
2004: Graduate Entry Pathway Program established at the Graduate School of Nursing
2005: PhD Program in Clinical & Population Health Research established at the Graduate School of Biomedical Sciences
2005: Massachusetts Biologic Laboratories opens new manufacturing and filling facility in Mattapan
2006: Craig Mello, PhD, Blais University Chair in Molecular Medicine and Howard Hughes Medical Institute Investigator, is awarded the Medical School's first Nobel Prize. Dr. Mello shared the 2006 Nobel Prize in Physiology or Medicine with Andrew Fire, PhD, of Stanford University, for their discoveries related to RNA interference.
2007: Michael F. Collins, MD, is named chancellor and Terence R. Flotte, MD, is named dean of the School of Medicine.  
2009: Groundbreaking for the Albert Sherman Center, a 500,000-square-foot research and education facility slated for completion in 2012.
2010: Ambulatory Care Center opens
2012: The Albert Sherman Center, a 500,000-square-foot research and education facility, completed and opens

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