Senior Program Manager, Public Plans Encounter Data

Site: Mass General Brigham Health Plan Holding Company Inc.

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

Responsible for managing all aspects of a large-scale and complex program and corresponding projects with a primary focus on encounter data operations and vendor program management. Leads and implements initiatives that support alignment with organizational goals and strategic planning. Oversees communication and collaboration with stakeholders across multiple lines of business external vendors and government agencies including CMS and state regulators. Develops the program schedule budget and various program and project plan details. Analyzes data prepares reports and provides regular updates to program leadership. Identifies and escalates issues and risks and recommends solutions. Leads and provides guidance and support to other team members.

Essential Functions
-Designs implements and manages all aspects of large complex multi-disciplinary programs and projects including end-to-end encounter data submission 837 EDI workflows and risk adjustment operations across Medicare Advantage (including D-SNP/One Care) and MassHealth Medicaid.
-Prepares analyzes and manages all program budgets including funding from multiple sources.
-Leads program and project teams and coordinates and delegates cross-project initiatives in partnership with IT coding compliance actuarial and vendor partners including Veradigm.
-Conducts research manages and analyzes data in systems within payer systems and CMS submission platforms including EDS RAPS and EDI environments (MAO-002/004 response file resolution) and develops reports and presentations to support programs.
-Identify potential risks issues and challenges associated with programs and develop mitigation strategies to minimize impact with particular focus on CMS acceptance and completeness rate targets critical error analysis and resolution and regulatory submission deadlines.

Education

• Bachelors Degree required and Masters Degree preferred; experience can be considered in lieu of a degree

Experience

• At least 8-10 years of program management experience required
• At least 1-2 years of team leadership experience required

Knowledge Skills and Abilities

• Strong oral and written communication skills including the ability to translate complex encounter data and regulatory requirements into clear guidance for technical and non-technical audiences.
• Ability to deliver presentations to a wide variety of audiences.
• Ability to effectively plan and facilitate meetings and workgroups including cross-functional initiatives involving IT vendors and clinical or operational teams.
• Excellent organizational skills and attention to detail ability to work independently manage multiple tasks and projects meet deadlines and manage to schedule particularly in a highly regulated environment with concurrent CMS and state submission timelines.

Working Conditions

• This is a remote role that can be done in most US states but preference is for local candidates who have the ability to come into the office for occassional team meetings

Remote

399 Revolution Drive

40

Regular

Day (United States of America)

Pay Range

$99465.60 - $141804.00/Annual

Grade

8

At Mass General Brigham we believe in recognizing and rewarding the unique value each team member brings to our organization. Our approach to determining base pay is comprehensive and any offer extended will take into account your skills relevant experience if applicable education certifications and other essential factors. The base pay information provided offers an estimate based on the minimum job qualifications; however it does not encompass all elements contributing to your total compensation addition to competitive base pay we offer comprehensive benefits career advancement opportunities differentials premiums and bonuses as applicable and recognition programs designed to celebrate your contributions and support your professional growth. We invite you to apply and our Talent Acquisition team will provide an overview of your potential compensation and benefits package.

8925 Mass General Brigham Health Plan Holding Company Inc. is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race color religious creed national origin sex age gender identity disability sexual orientation military service genetic information and/or other status protected under law. We will ensure that all individuals with a disability are provided a reasonable accommodation to participate in the job application or interview process to perform essential job functions and to receive other benefits and privileges of employment. To ensure reasonable accommodation for individuals protected by Section 503 of the Rehabilitation Act of 1973 the Vietnam Veterans Readjustment Act of 1974 and Title I of the Americans with Disabilities Act of 1990 applicants who require accommodation in the job application process may contact Human Resources at .

Mass General Brigham Competency Framework