What are the responsibilities and job description for the Senior Program Manager, Public Plans Encounter Data position at Mass General Brigham Health Plan?
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.
Mass General Brigham Health Plan Holding Company, Inc. is an Equal Opportunity Employer. By embracing diverse skills, perspectives and ideas, we choose to lead. 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.
Our promise as a people-first organization starts with our employees. AllWays Health Partners is committed to diversity, equity, and inclusion in our workforce, internal culture, and investments. As an equal opportunity employer, AllWays Health Partners recognizes the power of a diverse community and encourages applications from individuals with varied experiences, perspectives, and backgrounds.
Education
- Bachelor's Degree required and Master's 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
Mass General Brigham Health Plan Holding Company, Inc. is an Equal Opportunity Employer. By embracing diverse skills, perspectives and ideas, we choose to lead. 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.
Our promise as a people-first organization starts with our employees. AllWays Health Partners is committed to diversity, equity, and inclusion in our workforce, internal culture, and investments. As an equal opportunity employer, AllWays Health Partners recognizes the power of a diverse community and encourages applications from individuals with varied experiences, perspectives, and backgrounds.