State of Massachusetts Provider Operations Specialist in Quincy, Massachusetts

The mission of MassHealth is to improve the health outcomes of our diverse members, their families and their communities by providing access to integrated health care services that sustainably promote health, well-being, independence and quality of life.

The primary purpose is to assist the Director of Provider Operations/Customer Relations to coordinate, monitor, develop, and implement new and ongoing activities related to the MassHealth provider community relationship. Also to ensure that policies and objectives are fully supported by the Customer Services contractor and that the contractor communicates those policies and objectives accurately and in a manner that best represents MassHealth. Facilitating communication among all key stakeholders is a critical function as well.

Duties:

· Help monitor the customer service contractor’s compliance with contract requirements.

· Serve as the key contact with MassHealth staff , the contractor’s management, providers, and external agencies to provide information regarding MassHealth programs and initiatives

· Monitor Optum and Maximus contractor’s activities to help ensure their compliance to the contract by reviewing the daily and weekly management reports.

· Coordinate and ensure quality of provider material prepared by the contractor such as; educational and training material, Applications, instructional guides, transmittal letters and bulletins with the MassHealth’s Publications Unit .

· Coordinate and facilitate internal communication between the Office of Long Term Care, Office of Clinical Affairs , the Office of Provider and Plans and MassHealth Operations.

· Participates in initiatives to improve business processes and communication relations.

· Perform related duties, such as attending meetings and conferences, maintaining records, and preparing reports

· Update and develop user manuals to document Provider Operations procedures and protocols.

· Participate in meetings such as; Payment reform, the LTSS TPA, Optum, Maximus, Provider Review Committee, PRC and the Affordable Care Act, ACA.

· Represent Provider Operations at all audits and program integrity initiatives.

· Assists with the implementation of the MDE project to ensure ADA compliance within the provider community

· Attends the Provider Association Forum.

· Drafts monthly reports on accomplishments of the Unit.

· Completes other related responsibilities as requested.

Preferred Qualifications:

  • Knowledge of MassHealth claims processing.

  • Knowledge of MassHealth programs, policies and systems.

  • Proficient in computer software programs including Windows XP, Microsoft Office Word, Excel, PowerPoint, Access, etc.

  • Excellent analytic, interpersonal, project management, negotiation and leadership skills

  • Knowledge of the laws, rules, regulations, policies, procedures, specifications, standards and guidelines governing assigned unit activities.

  • Knowledge of the organizational structure and functions of the assigned agency.

  • Knowledge of the proper procedures for making and receiving agency telephone calls.

  • Knowledge of the types and uses of agency forms.

  • Knowledge of the laws, rules and regulations governing the state personnel system.

  • Knowledge of Microsoft software to produce reports that track and document unit productivity and impact.

  • Ability to identify and propose cost-savings initiatives.

  • Ability to create online reports on unit activities using Excel, Document Direct, Access, and other software tools.

  • Excellent verbal and written communication skills; ability to communicate effectively in both writing and presentation.

  • Ability to understand, explain and apply pertinent laws, rules, regulations, policies and procedures.

  • Ability to prioritize, balance multiple assignments, work under time constraints and adjust to changing circumstances.

  • Ability to work effectively both independently and as a team member.

Special Requirements:

Based on assignment, possession of a current and valid Massachusetts Class D Motor Vehicle Operator’s license or the equivalent from another state may be required.

Pre-Hire Process:

A criminal background check will be completed on the recommended candidate as required by the regulations set forth by the Executive Office of Health and Human Services prior to the candidate being hired. For more information, please visit http://www.mass.gov/hhs/cori

Education, licensure and certifications will be verified in accordance with the Human Resources Division’s Hiring Guidelines

  • Education and license/certification information provided by the selected candidate(s) is subject to the Massachusetts Public Records Law and may be published on the Commonwealth’s website.

As part of the hiring process, the Office of Human Resources will be verifying any college-level degrees conferred to the selected candidate. Additionally, any licensure required for the position will be verified. Information provided as part of the hiring process is subject to the Massachusetts Public Record Law and may be published on the Commonwealth’s website.

For questions, please contact the CYF Office of Human Resources at 1-800-510-4122 and select option #2.

This requisition will remain open until filled; however, first consideration will be given to those applicants that apply within the first 14 days.

MINIMUM ENTRANCE REQUIREMENTS: Applicants must have at least (A) four years of full-time, or equivalent part-time, professional, administrative or managerial experience in business administration, business management or public administration the major duties of which involved program management, program administration, program coordination, program planning and/or program analysis, and (B) of which at least one year must have been in a supervisory capacity, or (C) any equivalent combination of the required experience and the substitutions below.

Substitutions:

I. A Bachelor's degree with a major in business administration, business management or public administration may be substituted for a maximum of two years of the required (A) experience.*

II. A Graduate degree with a major in business administration, business management or public administration may be substituted for a maximum of three years of the required (A) experience.**

III. A Bachelor's or higher degree with a major other than in business administration, business management or public administration may be substituted for a maximum of one year of the required (A) experience.*

*Education toward such a degree will be prorated on the basis of the proportion of the requirements actually completed.

NOTE: No substitutions will be permitted for the required (B) experience.

An Equal Opportunity / Affirmative Action Employer. Females, minorities, veterans, and persons with disabilities are strongly encouraged to apply.

Job: *Administrative Services

Organization: *Exec Office Of Health and Human Services

Title: Provider Operations Specialist

Location: Massachusetts-Quincy - 100 Hancock Street

Requisition ID: 170003LS