• Provide technical assistance and advice to Agency personnel and others concerning assigned programs in order to exchange information, resolve problems and ensure compliance with established policies, procedures and standards.

• Research cost data of assigned programs for the rate review process with the Center for Health Information Analysis (CHIA).

• Implement annual coding updates, e.g., Current Procedural Terminology (CPT), Healthcare Common Procedure Coding System (level II) (HCPCS ) and International Classification of Diseases (ICD-10).

• Respond to inquiries from Agency staff, members, external professional provider associations and others in order to provide policy guidance and interpretation of the regulations.

• Performs related duties such as attending meetings, conferences, and provider training; maintaining records; and preparing reports.

• Research Medicaid Management Information System (MMIS) claims history and other files to resolve inquiries for assigned programs.

• Monitor the performance of contracted providers and applicable vendors to ensure compliance with MassHealth's contract standards and goals.

• Coordinate with the Center for Health Information Analysis (CHIA), Budget, Purchasing Strategies staff and other reimbursement entities to ensure that appropriate methodologies and rates are established for services reimbursed by the MassHealth agency.

• Working with team members to develop insightful display of data using visualization tools.

• Assisting in the interpretation of data and providing the team with data-driven recommendations.

• Prepare and disseminate quarterly Reconciliation Wrap APM Payments to key stakeholders.

• Participate in a variety of MassHealth initiatives including health care reform, cost containment and payment reform initiatives.

• Prepare and present formal recommendations to MassHealth executive team.

• Respond to inquiries from Legislatures, advocates, contracted providers, members and CMS regarding regulations, policy interpretation and contract specifications.

• Development of daily, weekly and monthly analysis and reports.

• Work directly with MassHealth leadership to identify analytical requirements, locate data sources, and create presentations to inform senior management.

• Assist with ad-hoc special projects aimed at improving CHCs operations and financial performance.

Required 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.

Preferred Qualifications:

• Strong interest in healthcare.

• Significant experience with Microsoft Excel, SQL is a plus, and statistical analysis.

• Experience with Microsoft Access or other database software, including Tableau, table management, query design and data importing and exporting a plus.

• Understanding of drivers of financial performance and statistical concepts.

• Knowledge of reimbursement principles and state and federal Medicare/Medicaid financing rules and regulations.

• Independent worker able to prioritize work to meet the needs of the organization and deliver regular and ad-hoc research, analysis and reports in a timely manner.

• Highly detailed and organized.

• Excellent communication skills

• Ability to work successfully with a range of team members, from entry level to executive level employees.

• Academic or professional experience in Business, HealthCare, or Finance preferred.

About MASSHEALTH:

To improve the health outcomes of our diverse members and their families by providing access to integrated health care services that promote 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 Reasonable Accommodation Online Request Form

For questions regarding this requisition, please contact the Executive Office of Health and Human Services Human Resources at 1-800-510-4122 Ext. #4

Qualifications

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.