MassHealth Premium Assistance Quality Assurance Manager
The Center for Health Care Financing (CHCF) helps state agencies, our primary clients, 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 and reduce the net cost of delivery.
Within the Third Party Liability (TPL) program we are seeking a MassHealth Premium Assistance Quality Assurance Manager to support the increasing efforts of the Benefit Coordination and Recovery Programs. The Quality Assurance Manager will evaluate and analyze member data for completeness and accuracy in all systems currently in use and will perform complex data analyses in connection with eligibility and payments data obtained from MA21, MMIS Document Direct Reports, COGNOS, Sohema and other systems.
The Quality Assurance Manager will apply new regulatory expertise to ensure proper and accurate determination (approval or denial) of payments on both new and established cases. In addition, the Quality Assurance Manager is expected to participate in continuous quality improvement in the PAU, submit reports as needed, draw conclusions on case analyses, make appropriate recommendations, and be involved in coordinating policy and process changes if necessary.
- Oversee and monitor activities of Premium Assistance Payment cases within the unit
- Work on revenue Premium Assistance projects
- Hire new employees, conduct corrective action and perform supervisory functions of corrective action and performance evaluations
- Provide on the job training and orientation for employees;
- Responsible for overseeing and assisting program staff to ensure that premium assistance cases are completed as directed
- Develop and implement procedures and guidelines to accomplish project objectives and goals
- Evaluate unit policies and procedures and make suggestions for improvement to the Revenue Operations Manager
- Review and analyze data and other information concerning assigned projects in order to determine progress and effectiveness and make recommendations for changes in procedures;
- Respond to inquiries from EOHHS staff and others concerning case issues
- Perform related duties such as maintaining records, preparing reports and presenting reports
- Interact on a professional level with EOHHS and other government agencies
- Work individually as well as being a team member
- Work internally and externally to resolve discrepancies for projects (this is in the original JD and will be added back in)
- Perform other duties as assigned
- Orienting, training, assigning, scheduling, coaching, counseling, and communicating job expectations to employees
- Enforcing policies and procedures.
- Achieves quality assurance operational objectives by contributing information and analysis to strategic plans and reviews;
- Preparing and completing action plans; implementing production, productivity, quality, and customer-service standards;
- Identifying and resolving problems; completing audits; determining system improvements; implementing change.
- Validates and determining operational and performance qualification; writing and updating quality assurance procedures.
- Performing compliance, and surveillance audits; investigating customer/member complaints.
- Prepares quality documentation and reports by collecting, analyzing and summarizing information. and enforcing quality standards.
- Bachelor’s degree in Finance, Public Administration, Business or related field, or equivalent
- 5 years experience in fiscal management, finance or public administration
- Proven skills in financial management or operational management
- Thorough knowledge of funding and revenue sources for health and human service programs
- Thorough knowledge of the federal and Massachusetts state regulations associated with the federal entitlement and block grant programs
- Experience with contract development and management
- Strong management and leadership skills