Managing Director, Health Care Finance Solutions

Managing Director, Health Care Financing Solutions

Under the general direction of the Deputy Executive Vice Chancellor (DEVC) of Operations, ForHealth Consulting, the Managing Director oversees the full spectrum of activities under the Health Care Financing Solutions division. The Managing Director is a senior executive who is accountable for driving ForHealth Consulting mission and business objectives. The position oversees all third-party liability, federal claiming, and program integrity projects, which includes Medicaid-related revenue recovery projects and cost avoidance activities in 14 states and the District of Columbia.

In Massachusetts, Health Care Financing Solutions provides key operational supports to the Executive Office of Health and Human Services (EOHHS) and MassHealth (Medicaid) in the following areas : Third-Party Liability and Benefit Coordination; Financial and Program Compliance; Federal Claiming for medical services provided at state hospital facilities and affiliated community-based programs; statewide management of the Massachusetts' School-Based Claiming program; administration of the Medicare Buy-in and Premium Assistance programs; and, technical support to the state's Health Information Exchange-Integrated Eligibility System (HIX-IES) initiative. Also, Health Care Financing Solutions administers the State Supplement Program on behalf of the Department of Transitional Assistance (DTA) and its approximately 190,000 program beneficiaries, conducts state lab billing for the Department of Public Health, and provides vaccine reimbursement services to about 200 local boards of health.

The Managing Director will be responsible for leading the strategic business and tactical operations of Health Care Financing Solutions, which includes the development, implementation and evaluation of Health Care Financing Solutions growth strategy, and for identifying sector needs and opportunities for business development both within Massachusetts and out of state in alignment with ForHealth Consulting strategic objectives. The successful candidate will maintain relationships with key business partners and other senior industry leaders in order to leverage best practices, evaluate emerging technologies and distribute knowledge internally to inform plans and strategies. The Managing Director will continually evaluate the performance of Health Care Financing Solutions against the strategic plan and recommend and / or implement adjusted allocations.

The ideal candidate will possess deep knowledge of how health care is financed in the United States and the key elements governing public assistance entitlement programs. The Managing Director will display outstanding interpersonal and operational leadership skills, and the ability to develop and sustain productive working relationships with key stakeholders and clients.

Responsibilities

Major Responsibilities :

• Lead the Health Care Finance Solutions division and ensure that all employees buy into the ForHealth Consulting and Health Care Finance Solutions vision.
• Set and implement the strategic direction and long-term business strategies of HCFS, ensuring alignment with ForHealth Consulting's vision, growth objectives, and an integrated organizational structure supported by measurable outcomes.
• Oversee all aspects of HCFS financial management, including budget development aligned with margin forecasts, regular financial performance reviews, mitigation of financial risks, and ensuring timely and accurate preparation of claims for federal reimbursement.
• Analyze opportunities for growth in the HCFS market segments to drive profitability; engage in product research and development utilizing market data; evaluate and execute opportunities for internal and external partnerships to increase market competitiveness.
• Develop and implement innovative product lines that integrate HCFS competencies, with a focus on operational excellence and outcomes-based deliverables.
• Set organizational key performance indicators, including productivity metrics, to gauge performance in all areas of responsibilities, ensuring alignment with ForHealth true north metrics.
• Identify opportunities to increase efficiency and speed up processes across the HCFS units and implement new processes and procedures, including automation, across the business.
• Conduct regular SWOT analysis to mitigate any potential financial, strategic and operational risks through industry and market changes.
• Promote HCFS services and expand the business portfolio by developing and maintaining key client relationships, negotiating contracts, representing HCFS at regional and national forums, and delivering presentations to diverse audiences to enhance visibility and credibility.
• Preserve and promote the HCFS talent pool by evaluating the workforce and launching tailored programs focused on employee engagement, competency build and succession planning.
• Collaborate with the Managing Director, Digital Solutions and team to plan and implement infrastructure services required to support the technology needs of ForHealth Consulting's diverse organization.
• Ensure compliance with all applicable federal and state laws, regulations, and oversight agency requirements, including responding to audits and inquiries, and fostering staff awareness and adherence to data privacy, security, and operational standards.
• Oversee and support department leaders in negotiating directly with clients concerning the scope, objectives, delivery dates and budgets for projects assigned to their section.
• Responsible for the fulfillment of the Interagency Services Agreement between ForHealth Consulting and the EOHHS by ensuring the development and implementation of the revenue operations, third-party liability, federal revenue and financial consultant activities described in that agreement.
• Participate on and be a key contributor to various senior leadership committees, as requested.
• Perform related duties as assigned.

Qualifications

Required Education : Master's Level Degree in business or related field or equivalent.

Required Experience :