PPR Specialist

UMass Med School; Taunton (MA); On-site; USD 50,000 - 64,000; Full time

Job summary

UMass Med School in Taunton, MA is seeking a PPR Specialist to perform medical billing, Medicaid/MassHealth coordination, and related administrative duties in the Public Provider Reimbursement department. You will manage data entry, meet deadlines, and assist with reports and training while ensuring confidentiality of patient information and compliance with regulations.

This full-time role requires 1–3 years of experience and an associate's degree or equivalent, with strong MS Office skills and

Qualifications

• Associate's degree or equivalent experience.
• 1-3 years of related experience.
• Familiarity with database and spreadsheet applications such as Microsoft Office including Word, Excel, Teams and One Drive
• Ability to communicate effectively
• Ability to adapt and change direction in response to changes in the business environment.

Responsibilities

• Perform and assist with medical billing and claiming activities, including any data entry, to obtain from liable payers reimbursement for services provided by state-operated facilities and community-based programs.
• Meet all claiming, eligibility and accounts receivable deadlines.
• Identify and coordinate access to Medicaid (MassHealth), Medicare and commercial health care insurance, Social Security Administration and other programs and benefits.
• Outreach to, proactively support and work with clients, families, guardians and representatives to complete and process applications, forms and other documents required to determine, redetermine, validate, reinstate and maintain health care coverage and related benefits.
• Perform and assist with broad spectrum of business services or specific services and focused activities.
• Review and analyze data, maintain and update spreadsheets, databases and systems and resolve discrepancies.
• Provide internal and external customers with professional customer service including responding to and following up on inquiries.
• Write, review, prepare and maintain business documents including reports, contracts, manuals, procedures and presentations.
• Participate in professional training and cross-training activities to enhance performance and skills.
• Participate in continuous quality improvement initiatives and projects. Foster compliance with state and federal rules and regulations.
• Work independently and as a team member and leader.
• Preserve confidential, protected health and personally identifiable information and files.
• Perform other duties and special projects as required.

Skills

Effective communication

Adaptability

Office software proficiency

Education

Associate's degree or equivalent experience

Tools

Meditech

MA21

MMIS

MMARS

MS Teams

Excel

OneDrive

Job description

PPR Specialist

Position Type: Full-Time

Shift: Non Exempt

Location: US-MA-Taunton

Minimum Salary: USD $50,024.00/Yr.

Maximum Salary: USD $63,897.60/Yr.

Overview

POSITION SUMMARY: The Public Provider Reimbursement (PPR) Department within Health Care Financing Solutions (HCFS) unit conducts statewide business services for several health and human services agencies of the Executive Office of Health and Human Services (EOHHS) to maximize revenue for the Commonwealth of Massachusetts. Revenue is obtained from private, state and federal resources to reimburse the Commonwealth for the costs of health care and related services provided by public institutions and community-based programs. The PPR Specialist is responsible for performing medical billing and claiming functions, activities to identify and coordinate access to health care insurance and related benefits, and administrative and clerical duties.

Responsibilities

• Perform and assist with medical billing and claiming activities, including any data entry, to obtain from liable payers reimbursement for services provided by state-operated facilities and community-based programs.
• Meet all claiming, eligibility and accounts receivable deadlines.
• Identify and coordinate access to Medicaid (MassHealth), Medicare and commercial health care insurance, Social Security Administration and other programs and benefits.
• Outreach to, proactively support and work with clients, clients' families, guardians and representatives to complete and process applications, forms and other documents required to determine, redetermine, validate, reinstate and maintain health care coverage and related benefits.
• Perform and assist with broad spectrum of business services or specific services and focused activities.
• Review and analyze data, maintain and update spreadsheets, databases and systems and resolve discrepancies.
• Provide internal and external customers with professional customer service including responding to and following up on inquiries.
• Write, review, prepare and maintain business documents including reports, contracts, manuals, procedures and presentations.
• Participate in professional training and cross-training activities to enhance performance and skills.
• Participate in continuous quality improvement initiatives and projects. Foster compliance with state and federal rules and regulations.
• Work independently and as a team member and leader.
• Preserve confidential, protected health and personally identifiable information and files.
• Perform other duties and special projects as required.

Qualifications

Required Qualifications:

• Associate's degree or equivalent experience.
• 1-3 years of related experience
• Familiarity with database and spreadsheet applications such as Microsoft Office including Word, Excel, Teams and One Drive
• Ability to communicate effectively
• Ability to adapt and change direction in response to changes in the business environment.

Preferred Qualifications:

• Medical billing or health care insurance experience
• Knowledge of state and federal rules and regulations related to health care finance
• Knowledge of state and federal information systems such as Meditech, MA21, MMIS and MMARS

Additional Information

PPR produces over one billion in gross charges to liable payers and generates over $700 million in net revenue to the Commonwealth. PPR conducts various business services statewide for 12 health and human services agencies and more than 20 public facilities that include hospitals, mental health centers and clinics, intermediate care and skilled nursing facilities, and various community-based services. Community-based services include Home and Community-based Waivers, Residential Rehabilitation Option and Targeted Case Management programs. The Revenue Operations Specialist will work closely with PPR staff and collaborate with the staff of EOHHS health and human services agencies that may include the Department of Developmental Services, Department of Mental Health, the Department of Public Health, the Department of Youth Services, the Division of Health Care Finance and Policy, the Executive Office of Elder Affairs, the Massachusetts Commission for the Blind, the Massachusetts Commission for the Deaf and Hard of Hearing, the Massachusetts Rehabilitation Commission, the Office of Medicaid, and the Chelsea and Holyoke Soldiers' Homes.