Medicaid Special Programs Specialist

Job Description

Job Description

Purpose

The Medicaid Special Programs Specialist contributes to the overall success of the Medicaid ACO Department ensuring specific individual goals, plans; initiatives are executed / delivered in support of the team’s business strategies and objectives. Ensures all activities conducted are in compliance with governing regulations, internal policies and procedures. With direction and support from the Medicaid Program Manager, this role will responsible for executing the operational and reporting requirements for both the Mass Health Community Partners (CP) and Flexible Services Programs. This includes making referrals and assignments into the CP program, occasional quality assurance on referrals and data entries, acting as a key contact for external partners, coordination and facilitation of team meetings, training and educating key personnel, and any data/reporting back to the state. This position is responsible for managing large, complex projects (IT and Programmatic) of the Medicaid ACO. This includes developing and meeting project objectives within established timelines, and managing associated risks. The Program Coordinator-Mass Health Community Partners/Flexible Services works with primary care practices, community partners, consultants, vendors, internal & external customers, subject matter experts, and cross-functional teams. Responsibilities include providing periodic updates and reports to ELT and the Director’s Team.

Accountabilities

• Champions a customer focused culture to deepen client relationships and leverage broader Health New England’s relationships, systems and knowledge.
• Understand how Health New England’s culture and the CX Promise should be considered in day-to-day activities and decisions.
• Actively pursues effective and efficient operations of their respective areas in accordance with Health New England’s Values, its Code of Conduct and the Associate Handbook, while ensuring the adequacy, adherence to and effectiveness of day-to-day business controls to meet obligations with respect to operational, compliance, and conduct.
• Champions a high performance environment and contributes to an inclusive work environment.

Essential Functions

• Train new providers and appropriate primary care practice staff on Flexible Service and Community Partner program initiatives, requirements, and workflows
• Pull program data, develop reports, and conduct ongoing analysis in accordance with Mass Health guidance and quality improvement initiatives
• Verify member eligibility for enrollment in programs from various sources such as provider referrals
• Act as a liaison with contracted Community Partners, Social Service Organizations, and primary care practices for any ad hoc needs
• Coordinate and facilitate Community Partner and Flexible Services Meetings
• Troubleshoot any payment and billing issues that may occur in either program
• Act as the subject matter expert for Flexible Services and Community Partner program specifications, guidance, and requirements provided by Mass Health
• Develop training materials and workflows for each program to be used for spreading knowledge regarding program requirements

Operations Oversight

• Review SOPs to ensure compliance with applicable regulations
• Provide technical leadership related to Medicaid ACO
• Attend necessary MassHealth meetings to assure understanding and scope of MassHealth technical and programmatic requirements
• Leadership of internal HNE IT and Configuration requests, monitoring progress and ensuring delivery.

Impact Assessments and Solution Recommendations; Product Systems Support and Interoperability

• Manage, analyze and classify issues and impacts on existing systems.
• Oversee the monitoring of all assigned systems and databases.
• Make recommendations regarding short vs. long term approaches to specific situations and champion proposed solutions and plans to obtain commitment from stakeholders

Education / Experience / Other Information (include only those that are specific to the role)

Bachelor’s Degree in Health Care Administration, Public Health, Social Work, Business Administration or related field with a minimum of 3-5 years of relevant administrative and program coordination experience. , or an equivalent combination of education and experience.

• Preferred Two (2) years of administrative and program coordination experience in a health care setting All
• Microsoft office product knowledge and experience particularly excel.
• Demonstrated experience supporting program operations through successful completion of tasks and projects
• Strong analytical skills to develop and analyze options, and recommend solutions for complex problems and issues
• High attention to detail and ability to interpret complex polices, rules and regulations
• Ability to manage multiple priorities, establish workflows and meet necessary deadlines
• Strong organizational, decision-making and problem-solving skills
• Excellent facilitation, conflict resolution and interpersonal skills
• Demonstrated success in facilitating or supporting quality improvement efforts
• Ability to generate professional, clearly written communication that is tailored to the audience
• Demonstrated experience with effective planning, problem solving, and continuous improvement processes
• Proficient with Microsoft applications, including Word, Excel, Access, Project, SharePoint and PowerPoint, Adobe Acrobat, Visio and other Mind Mapping software
• Sound business and technical acumen
• Demonstrated facilitation skills
• Excellent organizational and interpersonal skills
• Excellent written and verbal communication skills
• Proven ability to earn the trust of sponsors and key stakeholders.
• Valid Driver’s license

Working Conditions

Standard office environment, with extended period of time sitting, looking at monitors, typing on laptops and communicating via softphones/headsets for virtual meetings. Traveling may be required.