Reconciliation Program Manager at Mass General Brigham Health Plan in Somerville, Massachusetts

Job Description:

Mass General Brigham Health Plan is an exciting place to be within the healthcare industry. As a member of Mass General Brigham, we are on the forefront of transformation with one of the world's leading integrated healthcare systems. Together, we are providing our members with innovative solutions centered on their health needs to expand access to seamless and affordable care and coverage.


Our work centers on creating an exceptional member experience - a commitment that starts with our employees. Working with some of the most accomplished professionals in healthcare today, our employees have opportunities to learn and contribute expertise within a consciously inclusive environment where diversity is celebrated.


We are pleased to offer competitive salaries, and a benefits package with flexible work options, career growth opportunities, and much more.


The Reconciliation Program Manager will be responsible for ensuring all enrollment reconciliation activities are functioning accurately to assist with overall member experience. This includes responsibility for forecasting, planning, evaluating and implementation of all aspects of enrollment reconciliation In QNXT. Working closely with internal stakeholders- including the IT department- the Reconciliation Program Manager will work on discrepancy reporting functionality to allow the enrollment department to function in the most effective manner. The Reconciliation Program Manager will also lead all internal and external audit responses as well as ensure extracts to vendors have the necessary tools to be reconciled. The successful candidate will be able to help create vital beneficial process changes within the department to improve efficiency.



Principal Duties and Responsibilities:



• Responsible for ensuring all 834 transactions are being correctly reconciled.
• Work closely with IT to set requirements and user stories, as well as signing off on results and approving changes being promoted to production.
• Lead teams to enable system automation in Enrollment to reduce administrative costs, improve member experience and operational efficiency.
• Engage, empower and encourage staff; lead through change and adversity. Make decisions as needed and build consensus as appropriate.
• Identify and create the processes and align resources to accomplish key objectives; clearly convey and assign clear accountability for important objectives, deadlines, and expectations.
• Focus on internal reconciliation portal accuracy (MERP tool), as well as QNXT specific troubleshooters.
• Responsible for identifying and documenting process gaps and improvements.
• Responsible for ensuring reconciliation tools are in place for all enrollment activities including EDI file load, processing pended/ rejected transactions, paper & online enrollments.
• Responsible for managing all vendor extracts and error reports, documenting processes and ensuring issues identified by the team are communicated proactively.
• Lead for all data requests in the Enrollment team including audit responses.
• Resource and liaison to other departments, and external customers, in resolving account operational/transaction issues when applicable.
• Develops and maintains specific processes in accordance with regulatory guidelines set forth by the DOI and Attorney General's Office (AGO).
• Lead and drive corporate efforts to improve business processes and systems by collaborating with other departments.
• Key eligibility contact person for the Behavioral Health, Dental, Eye Med, ID Card and Pharmacy vendors.
• Work with IT to approve and prioritize tickets entered by team members.
• Attend and participate on project teams to provide feedback on Enrollment processes when applicable.
• Persist in accomplishing objectives, despite obstacles and setbacks to consistently achieve results.
• Build strong customer relationships and deliver solutions that meet customer expectations; establish and maintain effective customer relationships-both internal as well as external.
• Hold self and others accountable to meet commitments.
• Ensure diversity, equity, and inclusion are integrated as a guiding principle.
• Persist in accomplishing objectives to consistently achieve results despite any obstacles and setbacks that arise.
• 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

Qualifications:

• BA/BS degree required or the equivalent combination of training and experience, plus 5+ years of related experience.
• 5+ years of reconciliation experience required.
• 4+ years managing staff preferred and preferably within a managed care environment.
• Experience in SQL server
• Proficient with MS Office Suite, including Power BI, PowerPoint, Excel, and Word
• Understanding of QNXT and 834 EDI transactions
• Understanding of 820 transactions
• Problem-solving, leadership and independent initiative
• Customer Service capabilities



Skills/Abilities/Competencies:

• Demonstrate Mass General Brigham Health Plan's core brand principles of always listening, challenging conventions, and providing value.
• Bring fresh ideas forward by listening to and working with employees and the people we serve.
• Respect the talent and unique contributions of every individual and treat all people in a fair and equitable manner.
• Strong, demonstrated track record of an ability to execute on time, on budget, and on scope.
• Strong aptitude for technology-based solutions.
• Ability to inject energy, when and where it's needed.
• Current in healthcare trends.
• Demonstrated forward, visionary thinking; ability to see "what is" and envision "what could be."
• Ability to develop, introduce, defend, and gain support for a new ideas and approaches.
• Excellent leadership skills and leadership track record.
• Ability to translate and communicate complex topics in a variety of forums, tailoring communications to effectively fit and influence the targeted audience, strong executive presence, presentation, and communication skills. Strong verbal, active listening, and written communication skills required.
• Ability to view the long-range trends and cycles of the business and industry and see the "big picture."
• Ability to apply a variety of strategic frameworks to analyze problems and to guide and develop solutions.
• Ability to challenge the status quo and drive innovative thinking and the capability to successfully implement strategy.
• Excellent interpersonal skills, including the ability to influence others at all levels of an organization.
• Strong EQ; exercises self-awareness; monitors impact on others; is receptive to and seeks out feedback; uses self-discipline to adjust to feedback.
• Unquestionable integrity.



EEO Statement

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.