GENERAL SUMMARY OF POSITION:
Under the general direction of the Associate Director, the Operations Supervisor provides supervisory and management support to program operations on prior authorization and care management activities. This position is responsible for managing the day-to-day operations of administrative, reporting, and information systems/technology functions as related to contracted deliverables.
Collaborates with centralized departmental administrative and finance staff to ensure all personnel action activity related to hiring, firing, performance measurement, contracting, and funding are completed accurately and in a timely manner.
Working knowledge of MMIS
Health Care Finance Solutions 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, HCFS identifies 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 Public Health Initiatives unit at HCFS extends these services to state and local public health authorities to enhance their ability to sustain essential health care services to communities by identifying payers for these services and coordinating with other payers to seek reimbursement for these services. PHI provides its clients with comprehensive medical billing and accounts receivable mechanism, as well as other services, to maximize the collection of federal, third-party, and private reimbursement for health care and related services provided by state and local public health authorities. The program produces over $8 million in gross charges to liable payers and generates over $3.5 million in net revenue.
Under the supervision of the Assistant Director for the PHI unit, the Operations Supervisor and be responsible for the review and submission of claims within timely filing limits as well as ensuring any system updates related to program services are evaluated annually and updated as appropriate.