Claiming Operations Team Lead- REMOTE

POSITION SUMMARY: 

Under the general direction of the Operations Manager or designee, the Team Lead is responsible for client training, presentations, education, development & delivery of webinar trainings, and occasional travel for trainings at client locations. This position will be the lead customer service contact for client requests, escalated calls, and other assigned program areas.  The Team Lead is also responsible for coaching and educating unit operations staff including oversight of the call center team. 

ESSENTIAL FUNCTIONS:

• Develop and deliver client-related training, education, and presentations for the program.
• Participate in and lead CQI activities within the program, including system reports for accuracy and completeness of information, and identifying bugs & creating recommendations for enhancements.
• Provide guidance to team members regarding new client requests & projects to ensure information is accurately captured and communicated.
• Assist Operations Manager in administration of call center training, documentation and communication roll outs.
• Enhance and maintain customer inquiry tracking system and develop management reports.
• Participate in large program/department related projects and/or lead smaller client or program specific projects.
• Review and audit correspondence sent to stakeholders including providers, participants, Medicaid coordinators, and vendors for quality assurance.
• Receive and provide accurate and timely resolutions on escalated calls from stakeholders including providers, participants, Medicaid coordinators, and vendors.
• Initiate and maintain contact with key program personnel including staff, department heads and external parties.
• Work with the Operations Manager and Program Director to develop and conduct trainings for program staff related to the Random Moment Time Study and Medicaid claiming processes as needed. Training formats will include webinars, online training videos, and on-site/in-person trainings.
• Prepare multi-media presentations and reports utilizing a variety of software applications.
• Assist Director & Operations Manager in developing and providing staff training.
• Maintain current knowledge of state and federal regulations.
• Maintain the confidentiality of all business documents and correspondence according to HIPAA, university, and program guidelines.
• Adhere to appropriate state and federal regulations and departmental policies and procedures.
• Perform other duties as required.

REQUIRED QUALIFICATIONS:

• Bachelor’s degree in business or related field; or equivalent experience
• 3-5years of related experience within health and human service programs or related field
• Demonstrated ability to review, analyze and assess technical data and systems
• Excellent verbal and written communication skills
• Must possess strong organization and time management skills, operate in a flexible manner, and be able to work on multiple tasks under strict deadlines
• Demonstrated ability to research and resolve complex issues
• Ability to work independently and in group setting
• Proficiency with Microsoft Office software (Word, Outlook, Excel, Access), with focus on spreadsheet and database applications.

PREFERRED QUALIFICATIONS:

• Prior supervisory experience
• Prior presentation/training experience
• Prior customer service experience.

About the Health Care Finance Solutions and School Based Claiming

The Health Care Finance Solutions (HCFS) is a part of ForHealth Consulting (ForHealth), 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, ForHealth 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.

About School Based Claiming (SBC)

Federal financial participation (FFP) is available through Title XIX and Title XXI of the Social Security Act to match expenditures by cities and towns, regional school districts and charter schools (collectively, Local Education Agencies (LEAs)) for the provision of medically necessary medical services provided to Medicaid-enrolled students.  Also eligible for FFP are the LEA costs associated with performing Medicaid administrative activities related to the delivery of services and with performing qualifying outreach activities.  Collectively, this program is referred to as the School-Based Medicaid Program.

The SBC unit at HCFS works closely with Massachusetts and other states to develop, implement, and manage various activities that support direct service or administrative activity claiming to the Medicaid program.  To that end, SBC develops, maintains, and supports solutions for states to compile, report and review eligible expenditures for Medicaid Administrative Claiming, Direct Service Cost Report Reconciliation and Settlement, Medicaid Eligibility Matching, Random Moment Time Studies or other equivalent allocation methods to support the identification of Medicaid related costs. With a deep knowledge of federal Medicaid regulations, SBC optimizes claiming opportunities, while ensuring compliance with all applicable state and federal rules.   Today, SBC supports over 50,000 users in 9 states.