Massachusetts Jobs

The incumbent is responsible for monitoring the Office of Long Term Services and Supports (OLTSS) Third Party Administrator contractual functions that relate to provider enrollment and credentialing, claims operations, appeals, program integrity and reporting related to the Adult Foster Care (AFC) and Group Adult Foster Care (GAFC) programs. The coordinator will assess and triage issues and refer to the appropriate OLTSS staff for resolution. Duties and Responsibilities (these duties are a general summary and not all inclusive): Day-to-Day Operational Duties: Day-to-day monitoring of the OLTSS Third Party Administrator (TPA) contractual functions relating to provider enrollment and credentialing, claims operations, prior authorization, appeals, program integrity and reporting related to the AFC/GAFC programs, and ability to triage issues to the appropriate OLTSS internal staff. Provide assistance to AFC/GAFC senior manager during program regulation and rate regulation development and implementation, including working with IT team and Claims operation team. Ensure provider compliance with all applicable program rules, regulations and sub regulatory guidance including provider education, engagement and issue escalation. Provide assistance to AFC/GAFC senior manager on provider and constituent affairs services to resolve program policy and service delivery issues. Assist with reviewing, filing, and following up on AFC/GAFC critical incident reports. Coordinate the oversight of AFC/GAFC provider accreditation and fiscal soundness requirements in LTSS internal and provider systems. Lead key components of the implementation of EVV (Electronic Visit Verification) in GAFC. Lead key components of the implementation of the independent assessment entity. Lead key components of policy and program changes. Track and monitor multiple projects and initiatives relative to the programs, recommend changes in policy, communication strategies and/or program structure to the Senior Manager, Director of Community Based Programs and other members of the OLTSS leadership team. Monitor, research and facilitate the resolution of provider payment and pended claim issues. Effectively communicate priority project statuses, risks and outstanding decisions to OLTSS and MassHealth leadership both verbally and in written form under quick timelines. Actively utilize, update and support project management tools and plans. Assist in the orientation and training of new program staff and provide ongoing support and guidance to team members. Monitor TPA Board of Hearing (BOH) cases and collaborate with appropriate OLTSS internal staff. Provide program-related assistance to other units within the MassHealth, the Executive Office of Elder Affairs, and other agencies in the state government. Conduct ad-hoc analytics on program data. Program Integrity Duties: Conduct onsite visits with providers including but not limited to program audits, site reviews and provider education visits (limited travel required). Maintain databases and spreadsheets to provide current and accurate program and audit activities and follow-up on recommended corrective action or compliance issues raised in audits. Collaborate on TPA program integrity (PI) responsibilities and serve as the program integrity specialist for these programs including Audits, algorithm development and deployment and other PI activities. Additional Duties: Engage directly with stakeholders on program and policy changes. Work with MassHealth members/family to resolve issues that relate to the AFC/GAFC provider network and respond to requests for information regarding payment and policy questions. Collaborate with the Strategic Initiatives team in the management of all relevant TPA functions. Collaborate with finance and strategy on budget, cost reports, rate setting, modeling and implementation Collaborate with the OLTSS External Affairs team on drafting talking points, policies, memoranda, and meeting materials. Required Qualifications: • Ability to understand, explain and apply the laws, rules, regulations, policies, procedures, etc. governing assigned unit activities. • Ability to analyze and determine the applicability of data, to draw conclusions and make appropriate recommendations. • Ability to gather information by examining records and documents and by questioning individuals. • Ability to follow written and oral instructions in a precise, understandable manner. • Ability to establish rapport with others and maintain harmonious working relationships. • Ability to adjust to varying or changing situations to meet emergency or changing program requirements. • Ability to exercise sound judgment and the ability to exercise discretion in handling confidential information Preferred Qualifications: Knowledge and experience in LTSS program policy development, analysis and evaluation. Possess an understanding of the role of data and analysis in driving system change. Ability to develop and maintain effective working relationships with a range of LTSS stakeholders and partners. Knowledge of the Massachusetts health care industry and market dynamics related to LTSS. Knowledge and experience in program and/or provider audits. Proficiency in Microsoft Excel, Word, and PowerPoint; knowledge of Microsoft Project and Visio Knowledge of payment reform and care delivery reform strategies, including an understanding of the relationship between payment reforms, delivery system change, quality improvement and customer satisfaction in LTSS. Ability to understand, apply and explain pertinent laws, rules, regulations, policies and procedures. Knowledge of the methods used in the preparation of charts, graphs and tables, and of the methods of general report writing. Ability to analyze and determine the applicability of data, to draw conclusions and to make appropriate recommendations. Ability to gather and assemble information in accordance with established procedures, to compile statistical data and to communicate clearly, concisely, logically, accurately and persuasively in written, verbal and visual formats in internal, external and public settings. Ability to work independently and collaboratively. Ability to manage time and set priorities and reach decisions under pressure TO APPLY: Please upload both Resume and Cover Letter for this position when applying. First consideration will be given to those applicants that apply within the first 14 days. About MassHealth: To improve the health outcomes of our diverse members and their families by providing access to integrated health care services that sustainable & equitable health, well-being, independence, and quality of life. For more information about our agency and programs please visit: www.mass.gov/masshealth Pre-Offer 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. If you require assistance with the application/interview process and would like to request an ADA accommodation, please click on the link and complete the ADA Reasonable Accommodation Request Form. For questions, please the contact the Office of Human Resources at 1-800-510-4122 and select option #4. 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. _Comprehensive Benefits_ When you embark on a career with the Commonwealth, you are offered an outstanding suite of employee benefits that add to the overall value of your compensation package. We take pride in providing a work experience that supports you, your loved ones, and your future. Want the specifics? Explore our Employee Benefits and Rewards! *An Equal Opportunity / Affirmative Action Employer. Females, minorities, veterans, and persons with disabilities are strongly encouraged to apply. The Commonwealth is an Equal Opportunity Employer and does not discriminate on the basis of race, religion, color, sex, gender identity or expression, sexual orientation, age, disability, national origin, veteran status, or any other basis covered by appropriate law. Research suggests that qualified women, Black, Indigenous, and Persons of Color (BIPOC) may self-select out of opportunities if they don't meet 100% of the job requirements. We encourage individuals who believe they have the skills necessary to thrive to apply for this role. Job: Administrative Services* *Organization: Exec Office Of Health and Human Services *Title: *Adult Foster Care & Group Adult Foster Care Program Senior Coordinator Location: Massachusetts-Boston-1 Ashburton Place Requisition ID: 240007SP