Commonwealth Medicine UMASS Medical School
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Under the general direction of the Executive Director of UMass Health and Criminal Justice, the Associate Director of Finance and Claims Administration provides leadership over all administrative financial functions including accounting, finance, reimbursement, claims processing and accounts payable. The position is responsible for monitoring the financial performance of the Health and Criminal Justice program, generating financial and statistical reports, analyzing the department budgets, and reporting on budget execution throughout the year, and completing ad hoc reports, analyses and special projects as needed.
This position will coordinate all operational management activities related to the processing systems, system upgrades and work flows of claims operations. This position will work closely with the Executive Director to develop and executive initiatives to enhance existing functions and maintain support of department processes and requirements.
As a member of the senior leadership team, the Associate Director will provide support to the Executive Director in strategic planning, financial planning, service integration and service delivery.
- Oversees the performance of daily accounting functions including; invoicing, accounts payables/receivables, general ledger, balance sheet and payroll.
- Implements and enforces financial controls, policies and procedures
- Plan, direct, and manage consistent and insightful monthly and ad hoc reporting in support of the provision of accurate, timely, and objective financial data from which informed management decisions can be made.
- Work with CWM leadership and various constituents to lead the development and implementation of long-term, short-term and current year budgets and forecasts.
- Perform on-going and year-end analysis of financial results, coordinate adjustments as required. Identify trends and recommend corrective action if needed.
- Works with Executive Director in creating due diligence proforma models for potential development and acquisition projects.
- Oversees and manages the claims process to ensure accuracy, timeliness and completeness in order to meet contracted response times.
- Direct the claims systems testing and audits to ensure continuous operations
- Tracks production, error trending, develops workflow procedures and takes corrective action on claim system issues.
- Oversees and assists in backlog reduction, client contact on claim issues, client/provider education, and interdepartmental communication to expedite claim handling. Provides direction and training on extensive claim research, problem analysis and claim payments. Provides technical assistance on complex claims problems.
- Provide data analytics and reporting to identify opportunities to improve efficiency and effectiveness as a third party administrator.
- Responsible for overseeing the analysis of provider reimbursement and updating codes and fee schedules for correct reimbursement to providers and invoicing to clients.
- Act as a consultant for senior management on systems operation, recommend changes for system design, methods, procedures and workflows affecting claims operations
- Leverage existing technology by identifying opportunities to automate manual processes and identify opportunities to incorporate new technology into processes and flows.
- Performs related duties as assigned or required to meet Department, CWM, and University goals and objectives.
- Masters degree in finance, business administration or related field and 10 years experience health care administration or a related field, with a broad understanding of and experience in the changing and interrelated functions of health care delivery, or equivalent. Experience working with a third party administrator within a healthcare setting preferred.
- 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
- Experience with the development and maintenance of accountable infrastructure systems including information technology, personnel and finance systems
- Demonstrated outstanding verbal and written communication skills
- Proven problem solving skills including innovation, flexibility and creativity
- Demonstrated leadership skills including the ability to build productive teams and motivate individuals at all levels of an organization in the pursuit of common objectives