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Senior Manager of TPL Claims Programs - Hybrid Job Number: 2024-46860
Category: Administrative Professional
Location: Shrewsbury, MA
Shift: Day
Exempt/Non-Exempt: Exempt
Business Unit: ForHealth Consulting
Department: ForHealth Consulting - Third Party Liability - W401920
Job Type: Full-Time
Salary Grade: 46
Union Code: Non Union Position - W60 - Non Unit Professional
Num. Openings: 1
Post Date: Aug. 10, 2024

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 team's project activities, supervising all aspects of projects from inception to implementation as it 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.

• 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, financial outcomes, metrics, and benchmarks to 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 regular status of cost avoidance and revenue targets and report on potential risks for shortfalls or gains.
• Develop and implement policy, procedure, and program tracking standards regarding program monitoring and evaluation.
• Evaluate and assist in implementing changes 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 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 professionally 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.

Education:
Bachelor's degree in Finance, Public or Health Care Administration, Business, or other related area.

Work Experience:
7 – 9 years of experience in health and human services program management, fiscal management, finance, or public administration. Proven skills in financial management or operational management. Thorough knowledge of 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.

• 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.

About Health Care Finance Solutions and Benefit Coordination and Recovery Team

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