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GENERAL SUMMARY OF POSITION: 

The Public Provider Reimbursement (PPR) Department within the Center for Health Care Financing conducts statewide business services for several health and human services agencies of the Executive Office of Health and Human Services (EOHHS) to maximize revenue for the Commonwealth of Massachusetts.  Revenue is obtained from private, state and federal resources to reimburse the Commonwealth for the costs of health care and related services provided by public institutions and community-based programs.  The PPR Manager is responsible for oversight and management of medical billing and accounts receivable business services and activities to identify and coordinate access to health care insurance and related benefits.

MAJOR RESPONSIBILITIES:

• Manage and perform medical billing and accounts receivable activities to obtain from liable payers reimbursement for services provided by state-operated facilities and community-based programs.
• Manage and monitor the assessment and calculation of charges for care payments and the preparation, distribution and reconciliation of statements.
• Manage outreach activities to proactively support and work with clients, clients’ families, guardians and representatives to complete and process applications, forms and other documents required to determine, re-determine, validate, reinstate and maintain health care coverage and related benefits.
• Lead and perform activities to identify and coordinate access to Medicaid (MassHealth), Medicare and commercial health care insurance, Social Security Administration  and Veterans’ Administration programs and benefits  
• Oversee and manage business activities and day-to-day operations of assigned unit
• Responsible for the supervision and training of staff to include hiring, firing and evaluating/documenting performance. Review and analyze data, maintain and update spreadsheets, databases and systems and resolve discrepancies.
• Provide internal and external customers with professional customer service including responding to and following up on inquiries.
• Write, review, prepare and maintain business documents including reports, contracts, manuals, procedures and presentations
• Participate in continuous quality improvement initiatives and projects.
• Foster compliance with state and federal rules and regulations.
• Work independently and as a team member and leader.
• Preserve confidential, protected health and personally identifiable information and files.
• Perform additional job related duties as required or requested.

REQUIRED QUALIFICATIONS:

• Bachelor’s degree in Finance, Public Administration or Business; or equivalent.
• Seven years’ experience in fiscal management, finance or public administration or other related experience to include at least three years of supervisory or managerial experience
• Proven skills and experience in financial or operational management.
• Thorough knowledge of funding and revenue sources for health and human services programs.
• Contract development and management skills and experience.
• Strong management and leadership skills and experience.
• Excellent customer service, written and verbal communication skills.
• Demonstrated ability to prioritize and coordinate multiple tasks and meet deadlines.

PREFERRED QUALIFICATIONS:

• Strong Microsoft Office suite skills
• Medical billing or health care insurance coordination experience.
• Thorough knowledge of state and federal rules and regulations related to health care finance.
• Experience with state and federal information systems such as Meditech, MA21, MMIS and MMARS
• Ability to perform work with a sense of urgency

One PPR Manager will perform benefits and charges for care work for the Department of Developmental Services.

The second PPR Manager will perform revenue claiming for two Department of Public Health sites.

Home office location flexible.  Both DDS and DPH have various office locations across the Commonwealth.

Some on-site work may be necessary within the COVID safety protocols and requirements of the Departments.

Post COVID, some travel required to meet with and supervise staff.

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