Manager, DSNP (Senior Care Options and One Care) Claims
Manager, DSNP (Senior Care Options and One Care) Claims
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1 Vacancy
Job Description
Mass General Brigham relies on a wide range of professionals including doctors nurses business people tech experts researchers and systems analysts to advance our mission. As a not-for-profit we support patient care research teaching and community service striving to provide exceptional care. We believe that high-performing teams drive groundbreaking medical discoveries and invite all applicants to join us and experience what it means to be part of Mass General Brigham.
Job Summary
The Manager DSNP (Senior Care Options and One Care) claims will partner cross-functionally on the Senior Care Options and One Care implementation and testing activities. The Manager will be responsible for managing the day-to-day monthly and annual activities of the products to meet CMS and EOHHS regulatory requirements. This includes responsibility for monitoring accuracy and timeliness forecasting training and evaluating. The successful candidate will be an active participant on cross-functional teams to address strategic business initiatives and be a resource for both internal and external business partners.Qualifications
Principal Duties and Responsibilities:
Partner with the Director Medicare Advantage and DSNP Claims on the claims implementation of the Senior Care Options (SCO) and One Care products
Manage all aspects of the DSNP Claims Department and ensure Compliance with CMS and EOHHS regulatory requirements.
Monitor reporting of claim key metrics including but not limited to accuracy timeliness quality scores and inventory.
Align resources and delegate activities to accomplish key objectives; clearly convey and assign accountability for important objectives deadlines and expectations.
Act as the key contact for internal and external customers regarding Senior Care Options (SCO) and One Care claim processing questions.
Collaborate with other business areas such as Product IT Benefit Administration Configuration COB and Member Call Center to meet objectives and address issues.
Collaborate with vendors that impact claim processing
Develop and mentor team in order to create a high-performance service culture aligned with the strategic goals objectives and core values of the organization.
Research and resolve issues and escalate as needed.
Develop and review P&Ps and Job Aids
Oversee staff training to ensure all department policies and procedures are consistently applied.
Ensure Quality results are reviewed with team members on a regular basis and retraining occurs as needed.
Anticipate and meet or exceed internal and/or external customer expectations and requirements.
Management Responsibilities:
Inform engage inspire motivate and actively listen to employees.
Make decisions that put the needs of the people we serveour members providers brokers and employersfront and center.
Communicate and cascade information to employees in a timely manner and actively participate in the success of cross-organizational programs and initiatives.
Identify/create processes and align resources to accomplish key objectives; clearly convey and assign accountability for important objectives deadlines and expectations.
Hire participate in and/or recommend development measures and disciplinary actions up to and including termination; evaluate performance and supervise the work of all direct and indirect reports following established organizational policies procedures and practices.
Set clear goals and objectives use metrics to measure performance.
Provide coaching to improve performance and hold regular development meetings.
Hold self and others accountable to meet commitments.
Ensure diversity equity and inclusion are integrated as a guiding principle.
Persist in accomplishing objectives to consistently achieve results despite any obstacles and setbacks that arise.
Build strong relationships and infrastructures that designate Mass General Brigham Health Plan as a people-first organization.
Other duties as assigned with or without accommodation.
Qualifications:
Bachelors degree or the equivalent combination of training and 5 years of experience.
3 years of Medicare and/or DSNP claims leadership preferred.
Skills/Abilities/Competencies:
Demonstrate Mass General Brigham Health Plans core brand principles of always listening
challenging conventions and providing value.
Bring fresh ideas forward by listening to and working with employees and the people we serve.
Respect the talent and unique contributions of every individual and treat all people in a fair and equitable manner.
Strong demonstrated track record of an ability to execute on time on budget and on scope.
Strong aptitude for technology-based solutions.
Ability to inject energy when and where its needed.
Current in healthcare trends.
Demonstrated forward visionary thinking; ability to see what is and envision what could be.
Ability to develop introduce defend and gain support for new ideas and approaches.
Excellent leadership skills and leadership track record.
Ability to translate and communicate complex topics in a variety of forums tailoring communications to effectively fit and influence the targeted audience strong executive presence presentation and communication skills. Strong verbal active listening and written communication skills are required.
Ability to view the long-range trends and cycles of the business and industry and see the big picture.
Ability to apply a variety of strategic frameworks to analyze problems and to guide and develop solutions.
Ability to challenge the status quo and drive innovative thinking and the capability to successfully implement strategy.
Excellent interpersonal skills including the ability to influence others at all levels of an organization.
Strong EQ; exercises self-awareness; monitors impact on others; is receptive to and seeks out feedback; uses self-discipline to adjust to feedback.
Unquestionable integrity.
Supervisory Responsibilities:
Motivate and encourage staff; lead through change. Make decisions as needed and build consensus as appropriate. Communicate and cascade information to employees in a timely manner and actively participate in the success of cross-organizational programs and initiatives.
Set clear goals and objectives and use metrics to measure performance and hold staff accountable. Provide coaching to improve performance; hold regular development discussions with direct reports. Recognize staff for their contributions.
Inform engage inspire motivate and actively listen to employees.
Make decisions that put the needs of the people we serveour members providers brokers and employersfront and center.
Communicate and cascade information to employees in a timely manner and actively participate in the success of cross-organizational programs and initiatives.
Identify/create processes and align resources to accomplish key objectives; clearly convey and assign accountability for important objectives deadlines and expectations.
Hire participate in and/or recommend development measures and disciplinary actions up to and including termination; evaluate performance and supervise the work of all direct and indirect reports following established organizational policies procedures and practices.
Set clear goals and objectives use metrics to measure performance and hold employees accountable. Provide coaching to improve performance and holds regular development meetings.
Ensure diversity equity and inclusion are integrated as a guiding principle.
Additional Job Details (if applicable)
Working Conditions:
This is a hybrid role with onsite meetings at the office in Assembly Row Somerville 2x/month
Remote Type
Work Location
Scheduled Weekly Hours
Employee Type
Work Shift
EEO Statement:
Mass General Brigham Competency Framework
At Mass General Brigham our competency framework defines what effective leadership looks like by specifying which behaviors are most critical for successful performance at each job level. The framework is comprised of ten competencies (half People-Focused half Performance-Focused) and are defined by observable and measurable skills and behaviors that contribute to workplace effectiveness and career success. These competencies are used to evaluate performance make hiring decisions identify development needs mobilize employees across our system and establish a strong talent pipeline.
Required Experience:
Manager
Employment Type
Full-Time
