Senior Program Manager, Public Plans Encounter Data

Mass General Brigham is a not-for-profit organization that supports patient care, research, teaching, and community service. They are seeking a Senior Program Manager to manage large-scale programs focused on encounter data operations and vendor management, while ensuring alignment with organizational goals and effective communication with stakeholders.

Responsibilities:

• Designs, implements, and manages all aspects of large, complex, multi-disciplinary programs and projects, including end-to-end encounter data submission, 837 EDI workflows, and risk adjustment operations across Medicare Advantage (including D-SNP/One Care) and MassHealth Medicaid
• Prepares, analyzes, and manages all program budgets, including funding from multiple sources
• Leads program and project teams and coordinates and delegates cross-project initiatives, in partnership with IT, coding, compliance, actuarial, and vendor partners including Veradigm
• Conducts research, manages and analyzes data in systems within payer systems and CMS submission platforms including EDS, RAPS, and EDI environments (MAO-002/004 response file resolution), and develops reports and presentations to support programs
• Identify potential risks, issues, and challenges associated with programs and develop mitigation strategies to minimize impact, with particular focus on CMS acceptance and completeness rate targets, critical error analysis and resolution, and regulatory submission deadlines

Requirements:

• Bachelor's Degree required and Master's Degree preferred; experience can be considered in lieu of a degree
• At least 8-10 years of program management experience required
• At least 1-2 years of team leadership experience required
• Strong oral and written communication skills, including the ability to translate complex encounter data and regulatory requirements into clear guidance for technical and non-technical audiences
• Ability to deliver presentations to a wide variety of audiences
• Ability to effectively plan and facilitate meetings and workgroups, including cross-functional initiatives involving IT, vendors, and clinical or operational teams
• Excellent organizational skills and attention to detail, ability to work independently, manage multiple tasks and projects, meet deadlines, and manage to schedule, particularly in a highly regulated environment with concurrent CMS and state submission timelines