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GENERAL SUMMARY OF POSITION

The Health Care Finance Solutions (HCFS) unit provides consulting and operational services to state agencies and public municipalities within the Commonwealth of Massachusetts and nationally, currently serving 18 states.  Under the general direction of the Deputy Director of HCFS, the Program Director will manage certain revenue and cost savings programs and functions across state health and human service agencies.  Those functions will include directing and managing business operations that identify sources to offset health care costs by maximizing third party benefits and cost sharing opportunities, identifying liable payers, and billing, claiming, and recovering for the costs of health care services in a timely fashion.  In addition, the Program Director will lead the development and implementation of new business strategies and operations to meet internal and external client goals and develop and implement new projects and business opportunities.

MAJOR RESPONSIBILITIES:

• Direct and oversee business services, methods and strategies to meet and exceed cost savings and revenue targets for health and human service agencies
• Lead strategic planning efforts including the development and implementation of departmental performance goals and objectives related to operational and financial management and improvement
• Direct and lead program enhancement and expansion efforts including the identification of required resources, the implementation of teams; and the assessment of necessary skill sets and competencies to accomplish objectives
• Manage organizational change
• Provide direction and expertise in developing new revenue initiatives
• Provide business and operational management consulting services to client agencies, HCFS and ForHealth Consulting leadership staff
• Develop and maintain effective relationships with internal and external entities to continuously improve the quality and delivery of business services and operations including developing resolutions to issues, incorporating regulatory changes, and exchanging data
• Oversee, manage and prepare annual expense budgets
• Direct the analysis of potential cost savings and revenue projects and business opportunities
• Direct the development of client presentations, proposals, and procurement responses
• Direct the development and management of contracts for services and Interagency Service Agreements
• Attend federal/national conferences and monitor and assess changing federal/national industry indicators
• Ensure compliance with state and federal rules and regulations
• Provide monthly financial and operational reports to client agencies, CHCFS and ForHealth Consulting leadership staff
• Establish departmental policies, procedures and objectives, communicate changes to department staff, client agencies, HCFS and ForHealth Consulting staff
• Recruit, interview, hire, train, and evaluate staff
• Effectively work in a complex organizational and reporting environment
• Preserve confidential information and files
• Fulfill additional duties as required or requested

REQUIRED QUALIFICATIONS:

• Masters degree in Finance, Public Health, Human Services Administration, Business Management or equivalent.
• 10-15 years of solid experience and proven skills in financial management or operational management in increasingly responsible management positions, preferably in finance, health and human services.
• 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, leadership, team building, and customer service skills.
• Superior oral and written communications skills, with strong public speaking ability.

ADDITIONAL INFORMATION

About the Health Care Finance Solutions and Public Provider Reimbursement

The Health Care Finance Solutions (HCFS) is a part of ForHealth Consulting (ForHealth), the health care consulting division of UMass Medical School, Massachusetts only public medical school. As nationwide leaders in the development and implementation of health care reform, ForHealth and HCFS stay ahead of health care trends and help strategize and plan for changes that impact both health care delivery systems and patients on the local, state and national level.

Located in Shrewsbury, 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.

PPR unit at HCFS works closely with state health and human agencies and municipalities to enhance their ability to improve their federal claiming processes, find new revenue opportunities, and coordinate with other payers to capture revenue whenever possible. With a deep knowledge of federal Medicaid regulations, PPR maximizes opportunities, while ensuring compliance with all applicable state and federal rules.  PPR provides its clients with comprehensive medical billing and accounts receivable, as well as other services, to maximize the collection of federal, third-party, and private reimbursement for health care and related services provided by public hospitals, mental health clinics, psychiatric hospitals, skilled nursing facilities, and community-based programs.  Community-based services include Home and Community-based Waivers, Residential Rehabilitation Option and Targeted Case Management programs.  The program produces over $2 billion in gross charges to liable payers and generates over $1.25 million in net revenue. 

Work Environment:  Primarily remote with occasional travel in Massachusetts.