Public Provider Reimbursement Specialist- Westfield MA

UMass Chan Medical School; Westfield (MA); On-site; USD 52,000 - 72,000; Full time

Job summary

The University of Massachusetts Chan Medical School is seeking a Revenue Operations Specialist within the Public Provider Reimbursement (PPR) Department to support Massachusetts public facilities and community programs. The role focuses on medical billing, eligibility checks, and coordination of health coverage to maximize reimbursements.

You will work with MassHealth, Medicare and other programs, maintain databases and respond to inquiries with professional service, ensuring compliance with

Qualifications

• Associates degree or equivalent experience.
• 1–3 years of related experience.
• Experience with database/spreadsheet tools (Word, Excel, Teams, OneDrive).
• Strong written and verbal communication.
• Ability to adapt to changing business needs.

Responsibilities

• Perform medical billing and claiming activities to obtain reimbursements.
• Meet all claiming, eligibility and AR deadlines.
• Identify and coordinate access to Medicaid (MassHealth), Medicare and insurance programs.
• Assist clients and families with applications and documentation required for health coverage.
• Review data, maintain spreadsheets and resolve discrepancies.
• Provide professional customer service to internal and external customers.
• Prepare and maintain business documents and reports.

Skills

Communication

Adaptability

Education

Associates degree or equivalent experience

Tools

MOSAIC

Microsoft Office (Word, Excel, Teams, OneDrive)

Job description

The Public Provider Reimbursement (PPR) Department within Health Care Finance 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.

Essential Functions

• 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.

Required Qualifications

• Associates 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 MOSAIC

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 Veteran Homes.

The University of Massachusetts Chan Medical School welcomes all qualified applicants and complies with all state and federal anti-discrimination laws.