Financial Operations / Contract Program Manager - Multiple Locations
January 9, 2018
This position is responsible for the management of all processes and dataflow required to implement and operate special regulatory or contractual programs. Also serve as the primary point of contact with regards to these special populations for the NY State DOH, Local District Social Services (LDSS) offices and outside care management agencies. Manages and executes processes necessary to distribute funds to providers as a result of 'pass through' revenue. Develops policy and procedures for all programs and maintains documentation to insure financial integrity. Management of business requirements, implementation of data solutions, and maintenance/reporting are included in the job functions. Because the requirements of the state are often given with little notice or made effective retroactively, position requires flexibility and the skills necessary to make quick changes to databases, processes, reporting and documentation. Create, implement and manage a program to insure accurate payment of newborn claims and collection of supplemental revenue for special contracted institutions. Liaison with UHN contract managers and Hospital accounting directors to institute processes and procedure to insure claim payment revenue collection and program administration. Act as liaison to external partners, including the NY State DOH, Local District Social Services (LDSS) outside care management agencies and Providers targeted for incentive-based contracting.Build, implement and cross operationalize any state mandated programs according to NYS issued timelines and/ or provider contractual requirements. Insure operational infrastructure and cross departmental handoff is documented, monitored and tracked. Create/update and maintain databases/data requirements used to administer the Health Homes, Homeless population, Patient Centered Medical Homes Foster Care Children, Restricted Recipient programs, IPA administrative fees, Basic Quality Model Dollar distribution, DSRIP equity programs , Newborn and maternity payment, billing and encounters and any additional programs developed by NYSDOH or internally required to distribute funds to participating programs. Tracking dataUtilizing the Maximus E File to obtain information on the homeless member population and tracking additional information received from external sources, ie homeless shelters, returned mail.Retrieving and processing Patient-Centered Medical Home (PCMH) files from the state, reconciliation with core systems, and payment processing.Monitoring Equity Program distributionMonitoring and tracking medically fragile child population.Create standard and ad-hoc reporting for regulatory submission as well as Operations and Finance, as required.Interface with intersegment partners providing them with the necessary data and reporting required in order to administer their portion of the regulatory program. These include Pharmacy, Optum Behavioral Health, Optum Health Care Solutions and others.Ability to perform and deliver technical solutions when business requirements are unknown or poorly defined, and constantly changing.Balance program requirements with technical constraints while ensuring that the value of the program is realizedPlan, implement, manage and simplify automation of complex algorithms, systems and processes involving major functions or business unitsProactively ensure programmatic consistency and coordination across multiple teams and vendorsIdentify and work effectively with key stakeholders on complex cross team or work group projects or problemsCommunicate strategies, methodology and tools to work group members, project team members, and executive groupsAnalyze, validate, manipulate and reconcile large data sets to identify business risks and opportunities
Required Qualifications:College DegreeMedicaid Managed Care experienceExcellent verbal and written communication skillsData Base experience requires to monitor and report program financialsPreferred Qualifications: Knowledge of Maximus files, NY State Enrollment rosters, Health Home enrollment, billing and care management functionsExperience using UHC core systems and creating reporting using Smart data warehouseCareers at UnitedHealthcare Community & State. Challenge brings out the best in us. It also attracts the best. That's why you'll find some of the most amazingly talented people in health care here. We serve the health care needs of low income adults and children with debilitating illnesses such as cardiovascular disease, diabetes, HIV/AIDS and high-risk pregnancy. Our holistic, outcomes-based approach considers social, behavioral, economic, physical and environmental factors. Join us. Work with proactive health care, community and government partners to heal health care and create positive change for those who need it most. This is the place to do your life's best work.(sm) Diversity creates a healthier atmosphere: UnitedHealth Group is an Equal Employment Opportunity/Affirmative Action employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law.UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment. Keywords: financial analyst, financial statements, Medicaid Managed Care, NY State Enrollment rosters, Health Home enrollment, billing and care management functions
Our mission is to help people live healthier lives and to help make the health system work better for everyone.- We seek to enhance the performance of the health system and improve the overall health and well-being of the people we serve and their communities. - We work with health care professionals and other key partners to expand access to quality health care so people get the care they need... at an affordable price. - We support the physician/patient relationship and empower people with the information, guidance and tools they need to make personal health choices and decisions.