Sr Manager TPL Programs, Coordination of Benefits

3 weeks ago


Shrewsbury, United States InsideHigherEd Full time
Overview

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

• Lead and manage TPL programs, operations, and activities, and assist in the implementation of strategic goals and objectives.• Oversee and monitor activities of assigned unit.• Monitor operational efficiencies, and financial outcomes, metrics and benchmarks to provide continuity and ensure program operational success.• Make recommendations for priorities and program implementations.• Make recommendations for improvements to program operations.• Closely monitor the cost savings and revenue activities in the assigned unit to ensure the regular status of the cost avoidance and revenue targets and report on the potential risks for shortfalls or potential gains.• Develop and implement policy, procedure, and program tracking standards in regards to program monitoring and evaluation.• Evaluate and assist in implementing change and ongoing process improvements to increase the efficiency of operations and programs.• Work on TPL cost savings and revenue management projects.• 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.• Perform related duties such as attending staff meetings, maintaining records, and preparing reports.• Interact and represent the department on a professional level with the Massachusetts Executive Office of Health and Human Services (EOHHS) and other government agencies. Respond to internal and external entities concerning assigned projects.• Work internally and externally to resolve discrepancies for projects.• Perform other duties as assigned.

Qualifications

REQUIRED EDUCATIONBachelor’s degree in Finance, Public or Health Care Administration, Business, or other related area.REQUIRED WORK EXPERIENCE7 – 9 years of experience in health and human services program management, fiscal management, finance, or public administrationProven skills in financial management or operational management.Thorough knowledge of the federal and Massachusetts state regulations associated with TPL program activities.Thorough knowledge of cost savings and revenue sources for health and human service programs.Experience with contract development and management.Working knowledge of Microsoft Office applications and database management.Strong management and leadership skills.

 

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
Additional Information

About Health Care Finance Solutions and Benefit Coordination and Recovery Team

 

 

#LI-AC1



  • Shrewsbury, United States University of Massachusetts Medical School Full time

    Overview: 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...


  • Shrewsbury, United States BL Manager, LLC Full time

    **General Responsibilities** Assist in planning, coordinating and implementing a vibrant and social lifestyle experience that reflects the interests and needs of the residents and the community through the facilitation of Life Enrichment and/or INVEST programs and dining room service delivery in accordance with established policies, procedures and as...


  • Shrewsbury, United States InsideHigherEd Full time

    OverviewGENERAL SUMMARY OF POSITION:Under the general direction of the Principal Investigator, or designee, the Senior Research Program Manager oversees the application, implementation, progress, and evaluation of complex multi-year, multi-site research projects. The Senior Research Program Manager coordinates and mobilizes staff, faculty, consultants and...


  • Shrewsbury, United States InsideHigherEd Full time

    OverviewGENERAL SUMMARY OF POSITION:Under the general direction of the Principal Investigator, or designee, the Senior Research Program Manager oversees the application, implementation, progress, and evaluation of complex multi-year, multi-site research projects. The Senior Research Program Manager coordinates and mobilizes staff, faculty, consultants and...

  • Sr. Project

    6 days ago


    Shrewsbury, United States University of Massachusetts Medical School Full time

    Overview: Under the general direction of the Director or designee, the Senior Project and Portfolio Manager is responsible for overseeing, planning, developing and implementing large scale projects while strategically managing complex portfolios. The overall goal of this position is to ensure that large scale mission driven projects are executed within an...


  • Shrewsbury, United States University of Massachusetts Medical School Full time

    Overview: Under the direction of the Senior Director of Operation or designee, the Academic Programs and Training Manager will be charged with managing membership services, training, educational and research projects, and events including an annual conference in support of the Academic Consortium on Criminal Justice Health (ACCJH). This a large association...


  • Shrewsbury, United States University of Massachusetts Medical School Full time

    Overview: Under the direction of the Senior Director of Operation or designee, the Academic Programs and Training Manager will be charged with managing membership services, training, educational and research projects, and events including an annual conference in support of the Academic Consortium on Criminal Justice Health (ACCJH). This a large association...


  • Shrewsbury, United States University of Massachusetts Medical School Full time

    Overview: Under the general direction of the Sr. Finance Business Partner or Senior Director, Strategic Finance, or Director, Finance the Financial Analyst - FHC provides support of the daily financial activities of FHC business units. Including conducting financial analysis, budgeting, and planning to facilitate decision making by FHC Finance and BU...

  • Asst. Program Manager

    2 weeks ago


    Shrewsbury, United States Community Resources for Justice Full time

    Community Resources for Justice (CRJ) is a unique, 145-year-old nonprofit organization that provides direct care as well as research and consulting services within the areas of the Mental Health, Criminal Justice, and Public Policy fields. Our four divisions, Social Justice Services, Community Strategies, Behavioral Health, and the Crime and Justice...

  • Asst. Program Manager

    2 weeks ago


    Shrewsbury, United States Community Resources For Justice Full time

    Community Resources for Justice (CRJ) is a unique, 145-year-old nonprofit organization that provides direct care as well as research and consulting services within the areas of the Mental Health, Criminal Justice, and Public Policy fields. Our four divisions, Social Justice Services, Community Strategies, Behavioral Health, and the Crime and Justice...


  • Shrewsbury, United States University of Massachusetts Medical School Full time

    Overview GENERAL SUMMARY OF POSITION: Under the general supervision of the Building Equipment & Maintenance Manager or designee, the Sr. Facilities Specialist-Mechanic is responsible for the repair, maintenance, troubleshooting, installation, monitoring and operation of all building systems and equipment. Maintains records, installs, repairs, modifies and...


  • Shrewsbury, United States InsideHigherEd Full time

    OverviewUnder the general direction of the Executive Director or designee, the Program Manager (PM) is responsible for supporting enterprise-wide projects. The PM will assist the Director in leading and documenting project activities, and may lead sub-components of a project.  The PM is also responsible for planning and coordinating project related...


  • Shrewsbury, United States University of Massachusetts Full time

    Overview Under the general direction of the Department Manager or designee, the Program Operations Specialist will be responsible for providing technical support of specialized software applications utilized by clients. This position will specialize in Random Moment Time Study software and data requirements. The Program Operations Specialist will be...


  • Shrewsbury, United States Advocates Full time

    Overview Starting rate: $48,880 Advocates promotes a healthy work-life balance and offers many generous perks of employment and room for advancement. We are a strong-knit community that values the ideas and contributions of our staff. The Program Manager is responsible for overseeing the administration of the assigned program by providing leadership,...


  • Shrewsbury, United States InsideHigherEd Full time

    OverviewUnder the direction of the Senior Director of Operation or designee, the Academic Programs and Training Manager will be charged with managing membership services, training, educational and research projects, and events including an annual conference in support of the Academic Consortium on Criminal Justice Health (ACCJH). This a large association of...


  • Shrewsbury, United States InsideHigherEd Full time

    OverviewUnder the general direction of the Sr. Finance Business Partner or Senior Director, Strategic Finance, or Director, Finance the  Financial Analyst - FHC provides support of the daily financial activities of FHC business units. Including conducting financial analysis, budgeting, and planning to facilitate decision making by FHC Finance and BU...

  • Data Access

    1 month ago


    Shrewsbury, United States University of Massachusetts Full time

    Overview Under the direction of the appropriate departmental lead, or designee the Data Access and Operations Coordinator DCS is responsible for managing, coordinating, and providing oversight to all day-to-day privacy and data access administration and operational functions impacting UMass Chan business units. The Data Access and Operations...


  • Shrewsbury, United States Opus Inspection Full time

    **Job Purpose**: Plays a vital role in daily operational support, special technical projects, and the management of a team of field service representatives in support of the Massachusetts Vehicle Inspection Program. Supports the program by managing station service, recruitment, retention, and daily business operations as well as by participating in software...

  • Program Manager-

    1 week ago


    Shrewsbury, United States InsideHigherEd Full time

    OverviewThis requisition is being used as a sourcing tool and does not have an open vacancy. Your application to this req will add you to a pool of candidates for potential future openings. We still encourage you to apply directly to positions you feel best meet your background, as this will not replace your application for other openings.  The ForHealth...


  • Shrewsbury, United States OPUS INSPECTION TECHNOLOGIES INC Full time

    **Job Purpose** Plays a vital role in daily operational support, special technical projects, and the management of a team of field service representatives in support of the Massachusetts Vehicle Inspection Program. Supports the program by managing station service, recruitment, retention, and daily business operations as well as by participating in software...