Executive Director - Federal Claiming

Overview

Under the general direction of the Deputy Managing Director (DMD), Health Care Finance and Solutions (HCFS), the Executive Director(ED) for Federal Claiming, is responsible for providing leadership, direction and guidance in designated operations and support services including sales and business development, consulting, product development, service delivery and evaluation.  This position will monitor and address current revenue business services while providing an environment conducive to innovating and business expansion/development through program development, planning, service delivery and integration of the University's expertise and competencies within ForHealth Consulting/UMass Chan Medical School (UMass Chan). Specifically, the Executive Director will manage operational activities that achieve revenues totaling $1.5 billion dollars annually for HCFS clients and provide leadership to over 100 employees within the Federal Claiming business line.  Revenue sources include federal, state, private insurance plans, and private payers for various service delivery settings, including hospitals, community-based programs, medically necessary services provided in school or local board of health setting as well as expenditures related to Medicaid administrative activity.

The ED leads and facilitates the strategic direction of core HCFS Federal Claiming operations, business service expansion, consulting, and technical assistance opportunities, across the service continuum and age lifespan, including cross-departmental, collaborative solutions.  This position is responsible for the management, oversight and expansion of margin generating product lines, operations, and consulting for a high volume of private local, state and/or federal contracts.  The ED will align current operational and new business priorities for HCFS to the goals articulated in the UMass Chan and ForHealth Consulting strategic plans to ensure the proper allocation of capital, talent, and operating expenditures as well as promote business expansion and growth.

Responsibilities

Responsibilities

• Lead, manage, and expand multiple product service lines within the Federal Claiming unit focused on federal reimbursement, cost accounting and medical billing operations, consulting, and performance excellence for private, local, state or federal health and human service programs/services.
• Oversee and manage performance and service delivery requirements for high volume of margin generating contracts for large and diverse clientele.  Assure operations are appropriately resourced for optimal performance.
• Lead operations and performance excellence for strategic business and tactical operations, which includes the development, implementation, and evaluation of HCFS strategy
• Ensure quality and program compliance objectives are met and maintained across product lines and services and aligned with state and federal regulations as well as privacy and data security protocols.
• Manage and oversee various payer and vendor contracts for suppliers of services critical to meeting service or contract deliverables, including developing Requests for Proposal, evaluating and recommending vendors to hire, and developing and executing vendor contracts in collaboration with internal support units.
• Implement internal controls and unit-specific procedures and training to ensure compliance with all contractual requirements, including privacy and data security regulations and laws, collaborating with UMass Chan Office of Management and Information Security and ForHealth Consulting Finance, as needed and required. 
• Collaborate with UMass Chan IT, Digital Solutions, and/or outside vendors and formulate systems/program requirements for development, support, and/or maintenance.  Develop and manage internal and external vendor IT related workplans and budgets to meet program, operational, and fiscal targets.
• Oversee Federal Claiming management staff ensuring the success of critical day-to-day operational and administrative functions, including customer service, IT and telecommunications, program applications, secure file exchanges, and facilities and equipment.
• Manage, evaluate, provide constructive feedback, and support the professional development of Federal Claiming management staff.
• Provide leadership, guidance, and mentoring to program subject matter experts, program managers, supervisors, and staff.
• Cultivate workforce engagement, development, cross-training, and succession planning.
• Oversee client relationship management, leading and supporting Federal Claiming management to provide in- and out-of-state clients with the highest standard of operations and services, as documented by results achieved and the degree of client satisfaction and internal responsiveness to client requests, issues, or concerns.
• Work with shared infrastructure divisions within UMass Chan to assure their involvement in support of the HCFS core business growth in a fashion consistent with the overall goals and objectives of UMass Chan/ForHealth Consulting.
• Work independently to successfully establish departmental or client objectives and contract deliverables within respective timelines.
• Propose, develop, and lead new program initiatives and business development opportunities in accordance with core business and service line goals and objectives.  Collaborate with ForHealth Consulting leadership and support units to develop and implement business development plans, including marketing and conference strategies.
• Initiate, develop and maintain key relationships with clients, stakeholders, key potential business partners/suppliers and other UMass Chan departments to foster core business growth and/or collaboration.
• Facilitate contract negotiations with clients for new contract development or renewals, including but not limited to development of the scope of services, proposing pricing options and ensuring successful execution of contracts.
• Ensure quality, cost savings, and revenue objectives are met and maintained within the service line for optimal UMass Chan contractual relationships and establish indicators to monitor performance with all clientele.
• Develop and implement operational strategies to improve efficiency, maintain quality, and maximize revenues/margin.
• Establish infrastructure and products within the HCFS service line to further promote expansion, the development of metrics and analytics across the life span and quality of all related programs.
• Develop productive working relationships with key clients and engage stakeholder groups to improve the quantity and quality of HCFS offerings and to shape the development of business development strategy.
• Oversee matrixed, cross-organizational teams within Federal Claiming program units and across HCFS to provide consulting services for all HCFS opportunities.
• Ensure core growth strategy is relevant to the market and related service offerings are the highest level.
• Lead development and implementation of enhancements and innovations to Federal Claiming information technology applications.
• FINANCIAL AND CONTRACT SERVICES:
• Drive, manage and lead a business and financial plan to respond to enterprise and unit strategic goals, including performance of unit operations and creating a sustainable financial business model.
• Oversee operational and fiscal compliance and reporting requirements, including budget development and implementation, across the full range of contract reporting and established financial targets.
• Ensure the continued financial viability of Federal Claiming business lines through sound fiscal management.
• Direct the development, monitoring and analyzing of all labor, operating, and capital expense budgets in assigned areas and assure appropriateness of human and material resource allocations.
• Participate in the development of long-range planning and specific business and operating plan including identifying and procuring new sources of operating and capital funds.
• Forecast business development opportunities for new markets, including cost structure modeling and return on investment analyses.
• Meets the business and fiscal goals of Federal Claiming business lines as evidenced by:

o Providing financial oversight to all designated product lines.

o Monitoring and participating in budget forecasting and development of new business P&Ls and pricing structures.

o Developing and implementing strategic plans that promote the growth in out-of-state revenue generation.

           o Present information and updates to HCFS and Executive leadership related to business development strategy, new products                or services, new contracts or contract leads, department goals and objectives as well any operational risks.

Qualifications

REQUIRED EDUCATION
Master's Level Degree or equivalent in business, health services, or health administration.

REQUIRED WORK EXPERIENCE
10 + years of experience in increasingly senior managerial and executive positions preferably in health care finance, medical billing, federal claiming.
Strong commitment to public service with an entrepreneurial attitude, balanced with the ability to respect, galvanize, organize and coordinate constituent groups.
Proven administrative and management ability in a complex environment, preferably health care or other related service industry.
Demonstrated performance in strategic and financial planning and analysis.
Demonstrated ability to perform within budgetary constraints delivering a consistently break-even or profitable bottom line.
Substantial business development experience, program development and strategic planning experience.
Superb ability to interpret market trends including federal initiatives related to identifying business development and new product development ventures.
Comprehensive experience in understanding scope of service drafting for business and other agreements.
Contract writing, contract management, training and public speaking experience necessary.
Demonstrated ability working with healthcare professionals, excellent written, verbal and interpersonal skills.
Working knowledge of Microsoft Office Applications.

PREFERRED WORK EXPERIENCE
Substantial experience working with state governments and public agency leaders, in roles requiring senior level responsibility.
Deep expertise in the public health business sector including state and federal agencies (Medicare, Medicaid and state and federal regulations).
Experience and expertise in managing enterprise level projects and domains.