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GENERAL SUMMARY OF POSITION: 

Under the general direction of the Director or designee,  the Assistant Federal Claiming Director will direct the Medicaid administrative claiming function for Commonwealth Medicine (CWM) and the Medicare and Medicaid cost reporting and rate setting activities on behalf of the Executive Office of Health and Human Services (EOHHS). In fiscal year 2013, Medicaid administrative claiming was responsible for the generation of over $90 Million in federal revenue to the University.  Cost reporting and rate setting activities were responsible for the support of over $800 million in federal revenue to the Commonwealth during that same fiscal year.

MAJOR RESPONSIBILITIES:

• Oversee the Federal Reimbursement Unit through the process of obtaining federal reimbursement for UMMS.
• Oversee the completion and submission of yearly state and federal Medicare and Medicaid cost reports for state operated hospitals.
• Oversee the completion and submission of yearly charge books for state operated hospitals.
• Oversee the completion or yearly rate development activities for rehabilitative, home and community based waiver and targeted case management services provided by various EOHHS agencies.
• Manage the preparation of the computations of the cost of uncompensated care for state hospitals and provide consultative support to the Medicaid agency in this area.
• Manage the calculation of the Medicare Upper Payment Limit for state hospitals and provide consultative support to the Medicaid agency in this area.
• Be aware of new or enhanced opportunities for federal claiming by continually researching changes in the health care environment and by communicating with internal and external stakeholders.
• Propose and, if approved, implement new initiatives based on regulatory or programmatic changes that effect administrative claiming, cost reporting, cost allocation plan or rate development activities.
• Provide audit assistance and support to UMMS and EOHHS management in areas of responsibility
• Manage and direct workflow and priorities.
• Interview, hire, train, supervise and evaluate employees.
• Ensure that employees are trained and have the tools needed to perform their job duties.
• Collaborate with the staff of the Center for Health Care Financing, EOHHS, state agencies and other organizations to improve client partnerships, business services and operation.
• Draft department budget for approval.
• Maintain compliance with state and federal rules and regulations.
• Perform other duties as required.

REQUIRED QUALIFICATIONS:

• Masters’ Degree in Accounting, Finance, or Business Administration or equivalent experience.
• 8 years of solid experience and knowledge of accounting principles and financial report preparation.
• 5 Years of management experience in a complex environment.
• Demonstrated ability to lead, direct, and motivate staff.
• Knowledge of accounting and budgeting principals in the public sector
• Strong oral and written communication skills
• Demonstrated experience in computer tools, including spreadsheets, database management and word processing.
• Demonstrated ability to interpret federal and state laws and regulations.
• Travel to off-site locations required.

PREFERRED QUALIFICATIONS:

• Experience in Medicare and Medicaid cost reporting requirements and Medicaid rate development methodologies for community service programs.
• Experience in Medicaid financing for administrative costs.
• Knowledge of state information systems such as the Massachusetts Management Accounting and Reporting System (MMARS), MMIS and COGNOS.
• Knowledge of PeopleSoft financial systems.
• Knowledge of state and federal laws and regulations as related to health care finance.