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Opportunity Snapshot

This position offers you the opportunity to showcase your leadership skills and process savvy in a company that is growing strong and always looking for proven talent. You will provide leadership for a team comprised of direct reports and subcontractors for a program integrity audit project covering 11 states, on contract with the Centers for Medicaid and Medicare Services (CMS). This project is part of our federal services division, which grew more than 3000% (yes, thousand) over the past year, with more than half of that growth coming organically. In addition, you'll enjoy the amenities of a mid-sized company, including great people, a high-energy culture, strong values, and very little red tape in the decision-making process.

To be a good fit for this opportunity you will have a track record, in the healthcare industry, of successfully managing processes, achieving revenue targets, leading people and maintaining strong relationships with customers. A background in  auditing is preferred, and experience managing Medicaid projects would be a plus. We're looking for a professional with excellent project management skills and a demonstrated ability to manage P&Ls and budgets.

Founded in 1985, HMS offers one of the broadest portfolios of service to help government-sponsored healthcare plans recover billions of dollars and save billions more through cost avoidance. While others are cutting back, HMS is growing: our 2008 revenues of $184 million were up more than 20% over 2007, and that rate of growth is expected for 2009.

What Else You'll Bring to the Table

In addition to the qualifications detailed above, you'll need:

• A bachelor's degree.
• Ten or more years of professional experience with at least 3 years as a manager responsible for managing complex systems and work flow.
• Strong account management/customer management experience.
• Excellent interpersonal and communication skills (both written and oral).

Preferred but not required:

• An advanced degree.
• Prior experience managing CMS or State Medicaid projects.
• Experience managing projects involving several subcontractors.
• Knowledge of CMS contractor opportunities and procurement experience with CMS.

You also will need to be willing and able to travel up to 15% of the time. This project includes both desk and field audits and you will provide oversight to field audits once or twice a quarter, and also travel to HMS facilities in Westerville, Ohio and Omaha, Nebraska on occasion. About twice a year you'll meet face-to-face with CMS contacts in Washington, DC.

What's in It for You

Strong growth = career opportunity -- HMS' business is expanding across a number of service areas as well as into new markets, and as we grow so will our need for leaders who have proven their ability to deliver results. If you don't already have Medicaid or auditing in your background, you'll acquire knowledge of both quickly in this role.

High impact -- this program will take advantage of HMS's portfolio of best practices, systems and resources, and will be in operational mode as you come on board. At the same time, you will be able to influence the ongoing growth of this program, including coaching and developing your team as well as refining processes.

Great environment -- employee input is welcome in our culture, and even new employees can make a visible impact in short order. Because of our growth we are looking for people with the initiative and resourcefulness to "take the ball and run with it." Excellence and innovation are highly valued.

A market with no signs of slowing -- Medicaid and Medicare budgets are growing (CMS predicts current Medicare/Medicaid spending levels to double by 2015) and, with billions of dollars at stake, there is a strong emphasis among policy leaders (and the voting public) on cost containment and payment accuracy. HMS is taking advantage of this climate to drive solid growth.

Excellent compensation -- in addition to a competitive salary and bonus incentive program, we offer a comprehensive benefits package that includes 401(k) plan with generous employer match, flexible spending plans, and much more.

More About Your Role

If you're a good fit for this position, you already know most of what this job entails. However, to be sure we're providing a complete picture, here are some details.

HMS has been collaborating with CMS for some time on a five-year program integrity plan to help state agencies better assess overpayments and identify potential fraud in their Medicaid programs. The plan consists of three components: data analysis to identify high-potential targets, education to minimize overpayments due to misunderstanding of proper procedure, and this program, the CMS Audit MIC (Medicaid Integrity Contractor) engagement. In a nutshell, this project will receive targeted populations from the data analysis group, assess the data to identify potential overpayment trends and specific providers (pharmacies, physician offices, etc), develop and execute a plan for auditing each provider and generate an Audit Report to CMS.

The team you'll lead includes an Audit Manager, senior auditors and audit staff comprised of Certified Professional Auditors (CPAs), clinicians, and Certified Professional Coders (CPCs). There are also two subcontractors that bring specific expertise to the team, and you will manage those relationships and work share as well. This contract covers 11 states.

You will divide your time among three critical areas:

• Managing the process to ensure we meet and exceed performance expectations in the SOW. This will include everything from leading internal and external project management meetings to driving project implementation or improvement initiatives to managing the project budget.
• Managing the team, including scheduling, managing performance, acting as a resource, helping staff members grow their skills and more. You also will ensure that the subcontractors play the roles outlined for them in the SOW.
• Managing the customer as the main point of contact between HMS and CMS for the Audit MIC engagement. This will include weekly reporting and status calls with CMS and making occasional site visits. In addition to ensuring the client's satisfaction, we'll look to you to leverage HMS's project accomplishments to further HMS's long-term objectives with the Agency.

Keys to Success

To excel in this role you will assume ownership of the audit deliverables of this contract and bring a hands-on, action-oriented approach to ensuring delivery to schedule and performance expectations. Driving a young program takes a special kind of leader, one who can combine process savvy, organizational skills, and the leadership and motivational skills to take a team to ever-higher levels of performance.

If this sounds like the right mix of challenge and opportunity for you, and you meet the minimum qualifications, we want to hear from you!

Who We Are

Health Management Systems, Inc. (HMS) is an industry leader in the coordination of program integrity and benefits services for government healthcare programs. Since 1985 HMS has focused exclusively on the healthcare industry and during that time we have partnered with more than 45 Medicaid agencies, other state health programs, and more than 50 government-sponsored healthcare plans to help them recover billions of dollars, and save billions more through cost avoidance. Our portfolio of services includes coordination of benefits for Medicaid-Medicare, third-party liability, and pharmacy services; overpayment recovery; provider audits; medical support enforcement; and more.

We take a proactive approach to growing our company, both organically and via mergers and acquisitions, to ensure we provide our clients with a broad offering of best-of-breed cost containment strategies to meet their financial and operational goals.

We are an equal opportunity employer. EOE M/F/D/V

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