Executive Director, Federal Claiming

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 For Health 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 For Health Consulting strategic plans to ensure the proper allocation of capital, talent, and operating expenditures as well as promote business expansion and growth.

• 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 For Health 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…