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Under the general direction of the Executive Vice Chancellor of Operations (EVCO), Commonwealth Medicine (CWM), the Managing Director, Health Care Financing Solutions (HCFS) oversees the full spectrum of activities under the HCFS division. Commonwealth Medicine, the health care consulting and operations division of Umass Chan Medical School, partners with and supports both public and private health to address some of the most complex problems facing hard to reach, medically complex, and historically marginalized populations.

In Massachusetts, HCFS provides key operational supports to the Executive Office of Health and Human Services (EOHHS) and MassHealth (Medicaid) in the following areas: Third-Party Liability and Benefit Coordination; Financial and Program Compliance; Federal Claiming for medical services provided at state hospital facilities and affiliated community-based programs; statewide management of the Massachusetts’ School-Based Claiming program; administration of the Medicare Buy-in and Premium Assistance programs; and, technical support to the state’s Health Information Exchange-Integrated Eligibility System (HIX-IES) initiative. Also, HCFS administers the State Supplement Program on behalf of the Department of Transitional Assistance (DTA) and its approximately 190,000 program beneficiaries, and contracts with dozens of local organizations that participate in a statewide Community Partners Network to support the DTA’s outreach and enrollment and employment and training priorities. In addition, the HCFS division conducts state lab billing for the Department of Public Health and provides vaccine reimbursement services to about 200 local boards of health.

HCFS supports Medicaid-related revenue recovery projects or performs cost avoidance activities in 14 states and the District of Columbia. HCFS’ work often improves beneficiaries’ lives by helping them secure federal and state benefits to which they are entitled.

The Managing Director of HCFS is a senior executive who is accountable for driving CWM mission and business objectives. Supported by a workforce of over 300 full-time equivalent employees, the Managing Director oversees all third-party liability, federal claiming, and program integrity projects and is responsible for identifying sector needs and opportunities for business development both within Massachusetts and out of state in alignment with CWM strategic objectives. HCFS is a key contributor of annual revenue for CWM and of financial support to the Medical School.

The ideal candidate will possess deep knowledge of how health care is financed in the United States and the key elements governing public assistance entitlement programs. The Managing Director will display outstanding interpersonal and leadership skills, and the ability to develop and sustain productive working relationships with key stakeholders and clients, including: the federal government; the Commonwealth of Massachusetts and other state and local public sector partners; clinical systems and hospitals; outpatient and community-based health centers; trade associations and professional groups; consulting firms; and other health care entities.

• Lead the Health Care Finance Solutions division and ensure that all employees buy into the Commonwealth Medicine and Health Care Finance Solutions vision.
• In conjunction with the Executive Vice Chancellor, Commonwealth Medicine and the Deputy Executive Vice Chancellor, Operations set the overall strategic direction of the Health Care Finance Solutions division.
• Implement the long-term Health Care Finance Solutions business strategies to achieve Commonwealth Medicine’s strategic and growth objectives.
• In conjunction with the Executive Vice Chancellor, Commonwealth Medicine, set the Health Care Finance Solutions budgets in relation, and proportional to, the margin forecasts.
• Meet with the Commonwealth Medicine Director of Finance on a regular basis to review the financial performance of Health Care Finance Solutions business units.
• Analyze opportunities for growth in the Health Care Finance Solutions market segments to drive profitability; engage in product research and development utilizing market data.
• Conduct regular SWOT analysis to mitigate any potential risks through industry and market changes.
• Develop productive working relationships with key clients. Engage stakeholder groups to improve the quantity and quality of market/competitor intelligence and inform business development strategies.
• Contribute to a coordinated communications program that effectively articulates Commonwealth Medicine’s unique mission, vision, value and strategic goals to internal and external audiences and facilitates dialogue and decision-making among and between Commonwealth Medicine’s business units.
• Preserve and promote Health Care Finance Solutions’ talent pool by evaluating the workforce and launching tailored programs focused on the following: increasing diversity across all levels of the organization; offering value-added professional development training and opportunities for all staff; building leadership depth; and implementing a succession planning strategy.
• Collaborate with the Entity Information Officer (EIO) group to plan and implement infrastructure services required to support the technology needs of Commonwealth Medicine’s diverse organization.
• Devise a 5-year plan for Health Care Finance Solutions and work with the Commonwealth Medicine senior leadership team to oversee its implementation.
• Oversee communications with Commonwealth Medicine clients.
• Collaborates with Commonwealth Medicine senior leadership to support the implementation of strategic plans and process as well as the cost improvement efforts for the organization.
• Ensure that HCFS managers and staff comply with all federal and state laws, regulations and rules governing the management and use of protected and sensitive data, personal health information, personal identifying information and the storage of same.
• Assist department managers in negotiating directly with clients concerning the scope, objectives, and delivery dates for projects assigned to their section. Guides managers in their project and staff management responsibilities.
• Identify necessary resources to perform project work, and monitors work progress, including data analysis and report development, and oversees its timely completion.
• Delivers presentations of project results to University and state agency officials and staff as well as statewide, regional and national audiences; disseminates results through reports and academic publications.
• Work with the Health Care Finance Solutions leadership team to set organizational key performance indicators to gauge performance in all areas of responsibilities.
• Respond to inquiries and participates in all reviews from federal and/or state oversight agencies regarding any aspect of HCFS’ operations. Ensure that all managers and staff are aware of, and comply with, all laws and regulations applicable to HCFS’ activities.
• Responsible for the fulfillment of the Interagency Services Agreement between Commonwealth Medicine and the EOHHS by ensuring the development and implementation of the revenue operations, third-party liability, federal revenue and financial consultant activities described in that agreement.
• Serve as a business line leader for Health Care Finance Solutions’ financial services products both within and outside of Massachusetts. Coordinate out-of-state business expansion activities with Commonwealth Medicine
• Responsible for promoting Health Care Finance Solutions’s services to prospective clients, securing contracts.to expand the Center’s business portfolio and for timely achievement of growth targets for Health Care Finance Solutions’’s financial services products established by senior leadership of Commonwealth Medicine.
• Represent Health Care Finance Solutions at conferences, seminars, public forums and other appropriate venues.
• Participate on and be a key contributor to various senior leadership committees, as requested.
• Identify, evaluate and develop strategic alliances with external partners to enhance business opportunities for Health Care Finance Solutions’s financial products.
• Create an environment that supports the development of new financial services products and market those services to state agencies.
• Oversee the compilation of Commonwealth Medicine financial data that supports the preparation of a federal claim for reimbursement of CWM’s qualifying administrative support costs and certify the accuracy of those claims.

• Perform related duties as assigned.

REQUIRED EDUCATION
Master's Level Degree in business or related field or equivalent.

REQUIRED WORK EXPERIENCE
10 + years of experience working in a highly successful operational/management role with significant budget and/or P&L responsibility. .
7 – 10 years of thorough knowledge of all financing aspects of the Medicare and Medicaid programs and other key federal entitlement programs and experience in the interpretation and application of federal rules and regulations. 7-10 years experience working with Medicaid/Medicare programs, either at a federal or state agency level.
Has excellent written and verbal skills; writes and presents effectively; adjusts to fit the audience and the message; strongly gets a message across.
Exceptional leadership and people development skills.
A track record of creating actionable, multi-year strategic plans.
Has managed a large department and/or organization with many layers of staff and management.
Ability to design and implement effective performance measurement systems.
Proven experience managing multiple projects and priorities.