The Senior Enrollment Operations Coordinator for the MassHealth Enrollment Operations Unit is responsible for coordinating and overseeing certain daily and weekly enrollment related activities (e.g., the Notification of Birth enrollment process), assisting in the maintenance of the managed care provider and service area relationships in Medicaid Management Information System (MMIS), completing managed care enrollments and disenrollments, and performing special projects as needed.
Duties and Responsibilities (these duties are a general summary and not all inclusive):
·Oversee and coordinate the daily Notification of Birth enrollment process and managed care recoupment process.
·Create, distribute, and analyze weekly error reports.
·Participate in activities related to the yearly Accountable Care Organization (ACO)/Managed Care Organization (MCO) program changes and assist in operational processes related to Integrated Care Programs
·Perform Quality Control activities as directed.
·Provide support with staff training.
·Identify and help resolve escalated managed care enrollment related issues.
·Coordinate with program staff to ensure certain enrollment operations related issues are responded to and resolved in a timely manner.
·Perform managed care enrollments (MCEs), disenrollments and other operational processes and system maintenance as requested by leadership.
·Support MCE related compliance and readiness with MassHealth requirements and program initiatives.
·Perform Special Projects and other activities as requested.
Required Qualifications:
·Ability to set goals and strive for excellence or improvement.
·Ability to identify a problem or opportunity and take action to address current or future problems and opportunities.
·Ability to think through problems, organize information, and identify key factors and underlying causes to generate solutions.
·Ability to work cooperatively with others and be part of a team.
Preferred Qualifications:
·Knowledge of the methods and ability to prepare and use general reports, graphs, and tables.
·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 assemble items of information in accordance with established procedures.
·Ability to determine proper format and procedure for assembling items of information and maintain accurate records.
·Ability to write concisely to express thoughts clearly and to develop ideas in logical sequence.
·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.
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:
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.
For more information about our agency and programs please visit:www.mass.gov/masshealth
Pre-Offer Process:
A criminal and tax history 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 visithttp://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 theReasonable Accommodation Online Request Form..
For questions, please the contact the Office of Human Resources at 1-800-510-4122 and select option #4
The Senior Enrollment Operations Coordinator for the MassHealth Enrollment Operations Unit is responsible for coordinating and overseeing certain daily and weekly enrollment related activities (e.g., the Notification of Birth enrollment process), assisting in the maintenance of the managed care provider and service area relationships in Medicaid Management Information System (MMIS), completing managed care enrollments and disenrollments, and performing special projects as needed.
Duties and Responsibilities (these duties are a general summary and not all inclusive):
·Oversee and coordinate the daily Notification of Birth enrollment process and managed care recoupment process.
·Create, distribute, and analyze weekly error reports.
·Participate in activities related to the yearly Accountable Care Organization (ACO)/Managed Care Organization (MCO) program changes and assist in operational processes related to Integrated Care Programs
·Perform Quality Control activities as directed.
·Provide support with staff training.
·Identify and help resolve escalated managed care enrollment related issues.
·Coordinate with program staff to ensure certain enrollment operations related issues are responded to and resolved in a timely manner.
·Perform managed care enrollments (MCEs), disenrollments and other operational processes and system maintenance as requested by leadership.
·Support MCE related compliance and readiness with MassHealth requirements and program initiatives.
·Perform Special Projects and other activities as requested.
Required Qualifications:
·Ability to set goals and strive for excellence or improvement.
·Ability to identify a problem or opportunity and take action to address current or future problems and opportunities.
·Ability to think through problems, organize information, and identify key factors and underlying causes to generate solutions.
·Ability to work cooperatively with others and be part of a team.
Preferred Qualifications:
·Knowledge of the methods and ability to prepare and use general reports, graphs, and tables.
·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 assemble items of information in accordance with established procedures.
·Ability to determine proper format and procedure for assembling items of information and maintain accurate records.
·Ability to write concisely to express thoughts clearly and to develop ideas in logical sequence.
·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.
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:
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.
For more information about our agency and programs please visit:www.mass.gov/masshealth
Pre-Offer Process:
A criminal and tax history 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 visithttp://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 theReasonable Accommodation Online 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.
Salary placement is determined by a combination of factors, including the candidate’s years of directly related experience and education, and alignment with our internal compensation structure as set forth by the Human Resources Division’s Hiring Guidelines. For all bargaining unit positions (non-management), compensation is subject to the salary provisions outlined in the applicable collective bargaining agreement and will apply to placement within the appropriate salary range.
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.
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.
Salary placement is determined by a combination of factors, including the candidate’s years of directly related experience and education, and alignment with our internal compensation structure as set forth by the Human Resources Division’s Hiring Guidelines. For all bargaining unit positions (non-management), compensation is subject to the salary provisions outlined in the applicable collective bargaining agreement and will apply to placement within the appropriate salary range.
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.