Senior Director of Finance and Claims Administration


: $115,035.00 - $162,370.00 /year *

Employment Type

: Full-Time


: Financial Services - Banking/Investment/Finance

POSITION SUMMARY:Under the general direction of the Executive Director of Health and Criminal Justice, the Senior 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, reporting on budget execution throughout the year, and completing ad hoc reports, analyses and special projects as needed. This role oversees reviewing and adjudicating claims based on provider and client contractual agreements and claims processing guidelines. Responsible for compliance with UMass and Federal Bureau of Prisons policy and procedures in fulfillment of our role as a third-party administrator to the Federal Bureau of Prisons.Duties include budget development, data analytics and reporting, financial operations and management of expenses related to service delivery, information technology, and financial management systems for all lines of business within the Health and Criminal Justice program. This position will work closely with the Executive Director to develop and execute initiatives to enhance existing functions and maintain support of department processes and requirements.ESSENTIAL FUNCTIONS:As a member of the Senior Leadership team, provide support to the Executive Director in strategic planning, financial planning, service delivery, and service integration.Oversee and provide leadership for the coordination of administrative and financial services within the Health and Criminal Justice program.Work with shared infrastructure divisions within UMMS to assure their involvement in support of the correctional health program serves the program needs in a fashion consistent with the overall goals and objectives of UMMS/CWM.Implement systems including measures and controls for achieving contract compliance as it relates to our financial obligations.Lead and manage major business developments and corporate planning projects and assist in implementing strategic goals and objections, working closely, continuously, and according to the parameters and timelines agreed upon with the Executive Director.Review and implement new program initiatives related to claims administration and finance in accordance with program needs and in consultation with the Executive Director.Leverage existing technology by identifying opportunities to automate manual processes and identify opportunities to incorporate new technology into processes and flows.Perform other related duties as assignedFINANCIAL MANAGEMENT:Direct the business and fiscal affairs of the program including the preparation of annual budgets, monthly and quarterly financial reports, annual expense and profit forecasts, and annual capital budgets.Develop, implement and oversee administrative and fiscal systems such as cost-accounting, program budgeting and forecasting, common service chargeback, accounts receivable, accounts payable, purchasing and budget forecasting systems that meet the needs of the program while developing appropriate relationships to Federal and University systems.Develop and manage internal control procedures; ensure financial compliance with grants and contracts; coordinate external financial reviews.Design and implement a core data system that consolidates data, monitors financial and contract performance, linked to specific indicators, and generate reports required by the Federal Bureau of Prisons and the Executive Director as requested.Ensure compliance with financial contract specifications and state and federal business practices.Develop and implement performance initiatives designed to optimize and maximize programs revenue.Work with CWM leadership and various constituents to lead the development and implementation of long-term, short-term and current year budgets and forecasts.Report regularly to the Executive Director on financial management, including the formulation of recommendations for appropriate actions to ensure the continued maximization of expenses related to providing care and services in conformance with the program and CWMs overall strategic plan.Provide strategic recommendations based on financial analysis and projections; revenue/expense analysis.Present information and updates to executive staff as required and maintain reporting systems that provide the ability for executive and senior staff to oversee program service delivery and for staff to be accountable and accurate in their duties.Advise on contract pricing and cost analysis, including establishing a competitive range for hospital contract rates as well as provisions of services, and review of cost breakdowns to determine the profit margin on new business opportunity.Analyze and evaluate price and cost data contained in a variety of contract proposals to determine reasonableness of cost and sustainability of business line.CLAIMS MANAGEMENTOversees 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.Responsible for overseeing the analysis of provider reimbursement and updating codes and fee schedules for correct reimbursement to providers and invoicing to clients.REQUIRED QUALIFICATIONS:Masters degree in finance, business administration or related field and 8-10 years experience in health care administration or a related field.Proven administrative and management ability in a complex environment preferably health care or other related service industryDemonstrated 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 objectivesPREFERRED QUALIFICATIONS:Experience working as a third-party administrator within a healthcare setting preferred.
Associated topics: associate director, chief financial officer, chief investment officer, controller, director, finance director, financial director, general operations manager, supply, vice president * The salary listed in the header is an estimate based on salary data for similar jobs in the same area. Salary or compensation data found in the job description is accurate.

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