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GENERAL SUMMARY OF POSITION:

Working as a member of the Medicare Eligibility Enhancement Programs Team at Health Care Finance Solutions (HCFS), the Medicare Premium Assistance Senior Manager is responsible and accountable for oversight of all day-to-day operations of the Medicare Premium Assistance Unit.  The Medicare Premium Assistance Unit is responsible for administering the Massachusetts Medicare Buy-In Program on behalf of the MassHealth program and the Massachusetts Executive Office of Health and Human Services.

Under the direction of the Director or designee, the primary responsibilities of the Senior Manager include the implementation and management of Medicare Buy-In Program policies and procedures, program reporting, enhancement of current program initiatives and supervision of program staff. The Senior Manager will act as a liaison with various entities, including state and federal agencies, community resources and program recipients, to exchange information, coordinate activities, provide training, and resolve issues. The Senior Manager will be accountable for providing direct customer service to MassHealth members, their families and providers to provide information and investigate and resolve issues related to Medicare coverage, eligibility, and premium payments. The Medicare Premium Assistance Senior Manager’s primary goal is to ensure the accuracy and integrity of Medicare coverage information and premium payment transactions within MassHealth systems and manage Medicare Premium Assistance participation to assure coordination of Medicare benefits with MassHealth and support MassHealth as the Payor of Last Resort.

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.

REQUIRED QUALIFICATIONS:

• Bachelor’s 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.

PREFERRED QUALIFICATIONS:

• Knowledge of MassHealth and Medicare Premium Assistance eligibility requirements
• Experience working with federal health and human service agencies, including SSA and/or CMS
• Knowledge of health care reform law and the Patient Protection and Affordable Care Act
• Familiarity with MassHealth systems, including MA21 and the Massachusetts Medicaid Management Information System (MMIS), and how to effectively interpret its data logic and processes
• Demonstrated proficiency preparing and presenting project status and dashboard reports, cost savings and revenue tracking reports, project invoices and other ad hoc reports
• Ability to monitor large scale data transactions with Medicare to ensure accurate and timely processing
• Knowledge of quality assurance practices for complex data files to ensure validity of reporting and eligibility status
• Strong attention to detail and data analysis skills
• Experience handling and safeguarding Protected Health Information (PHI) and other Personally Identifiable Information (PII)
• Ability to synthesize complex information from multiple sources and convey it in an easily understand manner

About Health Care Finance Solutions and Medicare Eligibility Enhancement Programs Team

Health Care Finance Solutions (HCFS) is a part of Commonwealth Medicine (CWM), 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, CWM 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. 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.The Medicare Eligibility Enhancement Programs (MEEP) Team at HCFS works with state Medicaid programs to identify and coordinate federal and state benefits for program recipients, helping ensure that individuals receive all benefits to which they are entitled.  The MEEP team develops and implements benefit coordination initiatives which achieve cost savings and revenue opportunities for Medicaid agencies by ensuring federal benefits are appropriately identified and coordinated for state program recipients.The team focuses on identifying and coordinating eligibility for Social Security, Medicare and Medicare Buy-In benefits for state Medicaid recipients.  Current activities include identification of Medicare benefits, assistance with the Medicare application and enrollment process, review of eligibility for Social Security benefits and reconciliation of state Medicare premium payments.