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UPMC complies with all governmental requirements related to local, state, and federal COVID-19 vaccination for employment. The Jan. 13 Supreme Court of the United States decision that the Centers for Medicare & Medicaid Services federal COVID-19 vaccine mandate will move forward requires UPMC to ensure employees either get vaccinated or receive a requested medical or religious exemption.

If you are not yet vaccinated, we urge you to get a vaccine now. You can schedule your COVID-19 vaccination through UPMC or visit a non-UPMC provider or UPMC Urgent Care location.

Proof of vaccination is not required upon hire; however, employees will be responsible for ensuring post-hire compliance by getting vaccinated or requesting a medical or religious exemption.

For more information about UPMC’s response to COVID-19, please visit UPMC.com/coronavirus.

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   Current UPMC employees must apply in HR Direct

Manager, Government Programs - Revenue Max (Remote)

  • Job ID: 2300007J
  • Status: Full-Time
  • Regular/Temporary: Regular
  • Hours:
  • Shift: Day Job
  • Facility: UPMC Health Plan
  • Department: MEDICARE HCC
  • Location: Work From Home
  • Union Position: No
  • Salary Range: $38.32 to $64.85 / hour

Description

UPMC Health Plan is seeking a full-time Manager of Government Programs, Revenue Max to support the Medicare HCC department!

The Risk Adjustment Department is a large department with many responsibilities and diverse skill sets. This position will manage the Decision Support team, which is not only a critical area of the department but also a driver of Medicare Revenue for the UPMC Health Plan. 

The Manager of Government Programs is responsible for the development, implementation, and administration of collaborative oversight processes to ensure adequate financial performance with Medicaid, Medicare, and SNP lines of business. This position organizes and oversees cross-functional work groups that develop performance metrics, tracks progress against shared goals, and advises Senior Management on appropriate courses of action. Additionally, the Manager of Government Products facilitates the alignment of reporting and analytical approaches to provide coherent and consistent cross-functional tools for shared decision-making, performance evaluation, transparency, and predictive insights.

In addition to routine and ad-hoc reporting, this position will perform programmatic and strategic business research and analysis for revenue maximization, and is responsible for the oversight of activities that ensure revenue maximization and regulatory compliance. The Manager of Government Products will matrix to the Director of Operations, who has the overall responsibility for Government Programs' clinical and operational revenue maximization process, and solid line report to the Senior Director of Medicare & Medical Assistance.

The ideal candidate for this position will have advanced SQL skills, with Risk Adjustment knowledge/experience being preferred. 

This role is completely remote within the continental US.

 

Responsibilities:

  • Responsible for developing financial models to monitor and report back on revenue levels as compared to plan estimates, and exploring additional opportunities to meet corporate objectives and revenue growth.
  • Responsible for identifying causes for variances and recommending corrective action interventions, systemic solutions, or necessary short-term actions.
  • Responsible for leveraging cross-functional resources to expand visibility and enhance the predictability of expected results.
  • Manage and own other special projects, as assigned.
  • Manage third-party vendors or consultants hired to perform finance and analytical related functions.
  • Identify trends or anticipated events that will affect the cost structure and financial performance, create variance to plan, and appropriate cross-functional efforts to implement corrective actions where necessary.
  • Initiate communication through organizational channels to ensure that Senior Management is adequately apprised and has the opportunity to become involved where warranted.
  • Oversee daily financial and analytical reporting to maximize Government Programs' revenue.
  • Direct staff in the preparation of studies, monthly statistical revenue and forecasting analyses, reports, and recommendations on budgets and financial planning.
  • Analyze coding utilization to determine trends and provide key information to necessary management.
  • Adapt to changing work priorities and a fast-paced environment while maintaining a professional attitude.
  • Assist with ensuring all stakeholders are kept in all communications regarding decisions on strategic initiatives to maximize Medicare and Medical Assistance revenue.
  • Collaborate with actuarial department to create and maintain financial models using financial assumptions based on detailed analytics and pro-forma revenue development.
  • Partner with clinical staff in analyzing utilization and medical trends to forecast patterns of behavior in order to understand and maximize coding efforts in relationship to both HCC and CDPS methodologies.
  • Participate in various Federal and State Government Agency committee and subcommittee meetings and local and/or regional conferences involving existing and future financial and analytical revenue requirements.
  • Prepare weekly status reports to senior management relative to outstanding finance and analytical projects, ongoing monitoring, and completed assignments.
  • Serve as principal Health Plan expert and go-to person on financial reporting and data analytics.
  • Develop key indicator reports and financially reporting packages, interpretation, and recommendations to guide and assist in financial decisions.
  • Interpret, analyze, and report on proposed changes at the Federal or State level and assess the fiscal and/or operations impact of such changes.
  • Provide assistance to other units within the Government Programs department and to other departments as needed for Excel, Access, and other analytical tools.
  • Evaluate and provide revenue accruals for executive management and provide analyses and recommendations as necessary.

 

Qualifications

  • Bachelor's Degree in business finance, statistics, mathematics, health care management, or closely related discipline is required.
  • Relevant Master's Degree is strongly preferred.
  • 5-7 years of experience in healthcare or financial analysis.
  • Proven experience/knowledge of financial analysis reporting.
  • Knowledge of Federal Medicare and State Medicaid regulations required.
  • Advanced SQL skills experience strongly preferred.
  • Risk Adjustment knowledge/experience preferred.
  • Verifiable experience with Medicaid and/or Medicare managed care is preferred.
  • Excellent organizational and leadership capabilities with previous staff supervision.
  • Ability to continuously interact effectively and professionally with all levels of Health Plan staff.
  • Excellent written and verbal communication skills.
  • Ability to handle multiple priorities/projects in a fast-paced professional environment.
  • Proficiency in claim revenue analysis, variance analysis, and trend analysis.
  • Working knowledge of word processing and database software.
  • Working knowledge of CPT, ICD-9, HCPC's, UB, HCFA coding and an understanding of federal and state reimbursement payment methodologies is recommended.
  • Demonstrated performance in meeting deadlines, particularly in matrixed environments.


Licensure, Certifications, and Clearances:

  • Act 34

UPMC is an Equal Opportunity Employer/Disability/Veteran

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   Current UPMC employees must apply in HR Direct

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