Government Sales Manager manages and directs a sales force to achieve sales to government agencies. Designs and recommends sales programs and sets short- and long-term sales strategies. Being a Government Sales Manager evaluates and implements appropriate new sales techniques to increase the department's sales volume. May recommend product or service enhancements to improve customer satisfaction and sales potential. Additionally, Government Sales Manager ensures projects are completed on time and within budget. Acts as advisor to sales team regarding projects, tasks, and operations. May require a bachelor's degree in area of specialty. Typically reports to head of a unit/department. The Government Sales Manager manages subordinate staff in the day-to-day performance of their jobs. True first level manager. Ensures that project/department milestones/goals are met and adhering to approved budgets. Has full authority for personnel actions. To be a Government Sales Manager typically requires 5 years experience in the related area as an individual contributor. 1 - 3 years supervisory experience may be required. Extensive knowledge of the function and department processes. (Copyright 2024 Salary.com)
This is a remote role that can be done from most US states.
The Program Manager leads change efforts by working across the organization, leading matrixed and cross-functional resources to ensure efficient operations to support our Plan providers and members. This role may interact externally with Medicare, MassHealth, ACO partners, and other government agencies as well as provider partners to optimize performance.
The Government Programs, Program Manager is a self-directed, and collaborative position, with exposure to all levels of management, and requires a high level of operational as well as strategic focus. They collaborate with internal departments including Finance, Compliance, Marketing, IT, Configuration, Provider Network Management, Member and Provider Enrollment, Enterprise Project Management, Claims, and Customer Service.
Principal Duties and Responsibilities:
* Develop and implement Medicare & Medicaid policies and procedures for the Payment Integrity organization, in compliance with state and federal regulations.
* Oversee federal and state reporting requirements on behalf of the Payment Integrity Organization.
* Manage relationships with providers, members, state/federal agencies, and other stakeholders.
* Monitor and report on key performance metrics, such as recovery turnaround times and provider satisfaction.
* Maintain up-to-date knowledge of Medicare and Medicaid regulations, policies, and procedures.
* Identify opportunities for process improvements and implement changes as needed.
* Ensure compliance with all state and federal regulations.
* Ensures compliance with contractual, regulatory, NCQA, and corporate requirements, guidelines, and goals including turnaround times and reporting as it relates to the Medicare and Medicaid programs.
* Serve as the subject matter expert and point of contact for Medicare and MassHealth.
* Participate in CMS and MassHealth Payment Integrity related audits.
* Lead the preliminary review and response to payment integrity questions or inquiries from state and federal agencies.
* Conduct routine review of regulations and document preparation.
* Drive decision-making and ensure the end-to-end operational integrity of the Medicare and Medicaid payment integrity programs, including work with:
o Finance
o Benefits Administration
o Reimbursement Strategy
o Operational Alignment
o Member/Provider Enrollment
o Customer Service
o Provider Network Management
o IT
o Claims
* Lead organizational cross-functional reviews of end-to-end processes, establish, and validate workflows, and identify and resolve operational gaps.
* Develop, monitor, and maintain in-depth knowledge of Medicare and Medicaid program rules and requirements, and translate those rules and requirements into business and operational rules. Serve as the subject matter expert for CMS and MassHealth regulations and their impact on Payment Integrity operations.
* Attend and participate in internal Medicare and Medicaid meetings that involve Payment Integrity operations.
* Aggregate data from operations and finance teams to monitor program performance, including maintaining a dashboard of process and outcome measures. Identify opportunities for program improvement, intervention, and issue escalation.
* Track and resolve any program issues escalated to the Payment Integrity teams from providers or members, and track and obtain responses to program questions.
* Develop, review, and meet criteria related to enrollment operations, turnaround times, quality, regulatory and accuracy requirements.
* Monitor operational performance metrics to ensure plan reporting requirements are met timely and within plan compliance and enrollment deadlines.
* Identify and collaborate with partners within the Medicare or Medicaid network who may provide value added services/technology to aid in our government program efforts.
* Hold self and others accountable to meet commitments.
* Ensure diversity, equity, and inclusion are integrated as a guiding principle.
* 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:
* Bachelor's degree in healthcare administration, business administration, or a related field required or the equivalent combination of training and experience, plus 5 years of related experience.
* 5 years' experience in Medicare and Medicaid regulation, policies, and procedures.
* 2 years' experience in a health insurance setting.
Mass General Brigham 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.
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