Sr. Operations Manager - Coordination of Benefits (COB) Claims Processing (hybrid)
Overview:
About Health Care Finance Solutions and Benefit Coordination and Recovery Team Health Care Finance Solutions (HCFS) is part of ForHealth Consulting, a division of UMass Chan Medical School.
ForHealth Consulting programs combine academic excellence and public health service expertise to provide health care solutions ideal for the public sector and not-for profit organizations.
ForHealth Consulting helps 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.
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, HCFS identifies 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.
The unit conducts operations to ensure claims adjudicate and price accurately in the Medicaid Management Information System (MMIS) when the MassHealth member has other insurance coverage.
The unit participates in MMIS system updates and provides subject matter expertise for the development or revision of Third-Party Liability (TPL) policy and claim adjudication rules, edits, and audits.
The unit also conducts operations to recover MassHealth payments due to Medicare Retroactive enrollment.
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 maximum benefits for recipients, while ensuring cost effectiveness for clients.
General Summary of Position:
The Benefit Coordination and Recovery (BCR) team is seeking a Senior Manager who will oversee department operations, contract management, and revenue and recovery projects.
Under the general direction of the Deputy Director, or designee, the Senior Manager will lead the BCR teams project activities, supervising all aspects of projects from inception to implementation as relates to coordination of benefits & recovery.
The position will oversee the operations and financial performance of Coordination of Benefits (COB) Claims and Retroactive Medicare Recovery Project business units.
The role will manage multiple concurrent cost saving projects, conducting research and analyses for assigned projects.
The Senior Manager will utilize analytic consulting skills with a customer service focus to design and deliver quality products/services that meet or exceed client expectations.
The successful candidate will have an extensive medical claims billing and processing background as well as proven experience with leading teams in dynamic operation settings.
Responsibilities:
MAJOR
Responsibilities:
Evaluate and assist in implementing change to increase the efficiency of operations by reviewing reports and information from staffing Direct and manage revenue program by monitoring the progress of revenues and analyzing the data and reports Perform supervisory functions of hiring, corrective action and employee performance evaluation Make recommendations for priorities and program implementations Make recommendations for improvements to program operations Closely monitor the revenue activities in the assigned unit to insure the regular status of the revenues and report on the potential risks for shortfalls or potential gains Develop and implement policy and procedure standards in regards to program monitoring and evaluation Oversee and monitor activities of assigned unit Work on revenue management projects Identify state programs that may be eligible to receive FFP from the Federal Government Provide on the job training and orientation for employees Develop and implement procedures and guidelines to accomplish project objectives and goals Review and analyze data 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 assigned projects Perform related duties such as attending staff meetings, maintaining records and preparing reports Interact and represent the department 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 Perform other duties as assigned.
Qualifications:
REQUIRED
Qualifications:
Bachelors degree in Finance, Public Administration or Business or equivalent 7 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.
Additional Information:
Preferred
Qualifications:
Proven leadership skills; ability to successfully lead cross-functional teams using various virtual collaboration tools.
Strong oral and written communication skills Proven medical claims and billing experience.
Expertise in Health Insurance and Coordination of Benefits for Medicaid, Medicare and Commercial Payers and ability to apply knowledge to maximize cost savings initiatives for MassHealth.
Demonstrated knowledge of cost saving and revenue activities related to health care benefit programs and payment methodologies, such as Medicare, federal and state regulation for Title XIX Medicaid, and commercial health insurances.
Demonstrated experience preparing project status and dashboard reports, cost savings and revenue tracking reports, project invoices, and other ad hoc reports Adept at developing reports/dashboards, summarizing utilization and cost trends for internal and external stakeholders; and developing appropriate data visualization for reports Working knowledge of claims processing systems and code sets (CPT-4, HCPCS and ICD-9 / ICD10); HIPAA transactions; EDI transactions, and XML Demonstrated experience/skills with Data Warehouse concepts and Cognos Highly proficient in Microsoft Office suite (Word/Excel/Access/PowerPoint).
Experience with Microsoft SharePoint or other project management tools #LI-LG1 Recommended Skills Accounts Receivable Analytical Auditing Billing Business Informatics Claim Processing Estimated Salary: $20 to $28 per hour based on qualifications.
About Health Care Finance Solutions and Benefit Coordination and Recovery Team Health Care Finance Solutions (HCFS) is part of ForHealth Consulting, a division of UMass Chan Medical School.
ForHealth Consulting programs combine academic excellence and public health service expertise to provide health care solutions ideal for the public sector and not-for profit organizations.
ForHealth Consulting helps 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.
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, HCFS identifies 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.
The unit conducts operations to ensure claims adjudicate and price accurately in the Medicaid Management Information System (MMIS) when the MassHealth member has other insurance coverage.
The unit participates in MMIS system updates and provides subject matter expertise for the development or revision of Third-Party Liability (TPL) policy and claim adjudication rules, edits, and audits.
The unit also conducts operations to recover MassHealth payments due to Medicare Retroactive enrollment.
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 maximum benefits for recipients, while ensuring cost effectiveness for clients.
General Summary of Position:
The Benefit Coordination and Recovery (BCR) team is seeking a Senior Manager who will oversee department operations, contract management, and revenue and recovery projects.
Under the general direction of the Deputy Director, or designee, the Senior Manager will lead the BCR teams project activities, supervising all aspects of projects from inception to implementation as relates to coordination of benefits & recovery.
The position will oversee the operations and financial performance of Coordination of Benefits (COB) Claims and Retroactive Medicare Recovery Project business units.
The role will manage multiple concurrent cost saving projects, conducting research and analyses for assigned projects.
The Senior Manager will utilize analytic consulting skills with a customer service focus to design and deliver quality products/services that meet or exceed client expectations.
The successful candidate will have an extensive medical claims billing and processing background as well as proven experience with leading teams in dynamic operation settings.
Responsibilities:
MAJOR
Responsibilities:
Evaluate and assist in implementing change to increase the efficiency of operations by reviewing reports and information from staffing Direct and manage revenue program by monitoring the progress of revenues and analyzing the data and reports Perform supervisory functions of hiring, corrective action and employee performance evaluation Make recommendations for priorities and program implementations Make recommendations for improvements to program operations Closely monitor the revenue activities in the assigned unit to insure the regular status of the revenues and report on the potential risks for shortfalls or potential gains Develop and implement policy and procedure standards in regards to program monitoring and evaluation Oversee and monitor activities of assigned unit Work on revenue management projects Identify state programs that may be eligible to receive FFP from the Federal Government Provide on the job training and orientation for employees Develop and implement procedures and guidelines to accomplish project objectives and goals Review and analyze data 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 assigned projects Perform related duties such as attending staff meetings, maintaining records and preparing reports Interact and represent the department 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 Perform other duties as assigned.
Qualifications:
REQUIRED
Qualifications:
Bachelors degree in Finance, Public Administration or Business or equivalent 7 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.
Additional Information:
Preferred
Qualifications:
Proven leadership skills; ability to successfully lead cross-functional teams using various virtual collaboration tools.
Strong oral and written communication skills Proven medical claims and billing experience.
Expertise in Health Insurance and Coordination of Benefits for Medicaid, Medicare and Commercial Payers and ability to apply knowledge to maximize cost savings initiatives for MassHealth.
Demonstrated knowledge of cost saving and revenue activities related to health care benefit programs and payment methodologies, such as Medicare, federal and state regulation for Title XIX Medicaid, and commercial health insurances.
Demonstrated experience preparing project status and dashboard reports, cost savings and revenue tracking reports, project invoices, and other ad hoc reports Adept at developing reports/dashboards, summarizing utilization and cost trends for internal and external stakeholders; and developing appropriate data visualization for reports Working knowledge of claims processing systems and code sets (CPT-4, HCPCS and ICD-9 / ICD10); HIPAA transactions; EDI transactions, and XML Demonstrated experience/skills with Data Warehouse concepts and Cognos Highly proficient in Microsoft Office suite (Word/Excel/Access/PowerPoint).
Experience with Microsoft SharePoint or other project management tools #LI-LG1 Recommended Skills Accounts Receivable Analytical Auditing Billing Business Informatics Claim Processing Estimated Salary: $20 to $28 per hour based on qualifications.
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