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The Commonwealth of Massachusetts

Durable Medical Equipment, Oxygen and Respiratory Therapy Equipment, Prosthetics and Orthotics Program Specialist

Boston, MA

Job Description

The MassHealth Office of Long Term (Care) Services and Supports (OLTSS) is responsible for managing a robust system of supports for members of all ages who need services to enable them to live with independence and dignity in their daily lives, participate in their communities, and increase their overall quality of life. These services and supports may be provided in the home; in residential, day, and other community-based settings; or in certain facility-based settings, such as nursing homes and chronic disease rehab hospitals. Additionally, OLTSS manages fully capitated integrated care plans primarily for dually eligible individuals (i.e. Medicare and Medicaid): Senior Care Options (SCO), the One Care Program, and the Program of All-Inclusive Care for the Elderly (PACE). OLTSS also oversees 10 home and community based (HCBS) Medicaid waiver programs that provide specialized services and supports to especially vulnerable OLTSS populations. OLTSS is responsible for ensuring that services provided in any setting and all delivery systems are member-focused, accessible, of the highest quality, and delivered in a cost-effective manner.

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Program Specialist Duties:

The Program Specialist will assist the Durable Medical Equipment, Oxygen, Orthotics and Prosthetics (DMEPOS) program manager and the DMEPOS Senior Manager with specific duties that fall within the team responsibilities. The DMEPOS program supports approximately 86,000 MassHealth members in order to enable them to stay in the community. Responsibilities will include provider, member, and advocate stakeholder engagement; provider education; meeting planning; program integrity;; program and rate regulation development; and policy planning.

Day-to-Day Operational Duties to support the DMEPOS team:

  • Day-to-day monitoring of the OLTSS Third Party Administrator (TPA) contractual functions relating to provider enrollment and credentialing, claims operations, prior authorization, appeals, program integrity and reporting related to the relevant programs, and ability to triage issues to the appropriate OLTSS internal staff.
  • Work with MassHealth members/family to resolve issues that relate to relevant provider networks and respond to requests for information regarding payment and policy questions.
  • Provide assistance to the Program Manager during program regulation and rate regulation development and implementation, including working with IT team and Claims operation team.
  • Ensure provider compliance with all applicable program rules, regulations and sub regulatory guidance including provider education, engagement and issue escalation.
  • Provide assistance to the Program Manager on provider and constituent affairs services to resolve program policy and service delivery issues.
  • Assist with reviewing, filing, and following up on critical incident reports.
  • Manage, track and monitor multiple projects and initiatives relative to the programs, recommend changes in policy, communication strategies and/or program structure to the Director of Fee for Service (FFS) Home Based Programs and other members of the OLTSS leadership team.
  • Effectively communicate priority project statuses, risks and outstanding decisions to OLTSS and MassHealth leadership both verbally and in written form under quick timelines.
  • Assist in the orientation and training of new program staff, and provide ongoing support and guidance to team members.
  • Provide program-related assistance to other units within the MassHealth, the Executive Office of Elder Affairs, and other agencies in the state government.

Program Integrity Duties:

  • Conduct onsite visits with providers including but not limited to program audits, site reviews and provider education visits (limited travel required).
  • Maintain databases and spreadsheets to provide current and accurate program and audit activities and follow-up on recommended corrective action or compliance issues raised in audits.
  • Collaborate on TPA program integrity (PI) responsibilities and serve as program integrity specialist in the relevant program area.

Additional Duties:

  • Assist Program Manager in working with provider stakeholder groups to solicit feedback or provide training, as needed.
  • Collaborate with the Strategic Initiatives team in the management of all relevant TPA functions.
  • Collaborate with MassHealth Finance and Strategy Teams on budget, cost reports, rate setting, modeling and implementation of a value based payment methodology, implementation of risk adjusted rates for coordinated care.
  • Collaborate with the OLTSS External Affairs team on drafting talking points, policies, memoranda, and meeting materials.
  • Assist with managing the MassHealth Payment and Coverage Guideline Tools and collaborate with MMIS/claims to provide system updates and changes.
  • Assist with managing contracts obtained through RFR's, ISA's and preferred supplier contracts.

Preferred Qualifications

MassHealth is seeking candidates who possess the following qualifications:

  • Understanding of the general medical needs of Medicare and Medicaid populations
  • Ability to develop and maintain effective working relationships with a range of LTSS stakeholders and partners.
  • Knowledge of the Massachusetts health care industry and market dynamics related to LTSS.
  • Ability to understand, apply and explain pertinent laws, rules, regulations, policies and procedures.
  • Knowledge of the methods used in the preparation of charts, graphs and tables, and of the methods of general report writing.
  • Ability to analyze and determine the applicability of data, to draw conclusions and to make appropriate recommendations.
  • Ability to gather and assemble information in accordance with established procedures to compile statistical data and to communicate clearly, concisely, logically, accurately and persuasively in written, verbal and visual formats in internal, external and public settings.
  • Ability to work independently and collaboratively.
  • Ability to manage time and set priorities and reach decisions under pressure.
  • Ability to lead meetings and manage projects.
  • Proficiency in Microsoft Excel, Word, and PowerPoint; knowledge of Microsoft Project and Visio is a plus.
  • Experience managing third-party contracts preferred.
  • Strong interpersonal skills.
  • Commitment to health equity.

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:

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, please the contact the Office of Human Resources at 1-800-510-4122 and select option #2.

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.

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!

Executive Order #595: As a condition of employment, successful applicants will be required to have received COVID-19 vaccination or an approved exemption as of their start date. Details relating to demonstrating compliance with this requirement will be provided to applicants selected for employment. Applicants who receive an offer of employment who can provide documentation that the vaccine is medically contraindicated or who object to vaccination due to a sincerely held religious belief may make a request for exemption.

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.

Client-provided location(s): Boston, MA, USA
Job ID: Commonwealth_of_Massachusetts-230003QM
Employment Type: Other

Perks and Benefits

  • Health and Wellness

    • Health Insurance
    • Health Reimbursement Account
    • Dental Insurance
    • Vision Insurance
    • Life Insurance
    • Short-Term Disability
    • Long-Term Disability
    • FSA
    • HSA
    • Mental Health Benefits
  • Parental Benefits

    • Adoption Assistance Program
    • Family Support Resources
  • Work Flexibility

    • Flexible Work Hours
    • Hybrid Work Opportunities
  • Office Life and Perks

    • Commuter Benefits Program
  • Vacation and Time Off

    • Paid Vacation
    • Paid Holidays
    • Personal/Sick Days
    • Volunteer Time Off
  • Financial and Retirement

    • Pension
    • Financial Counseling
  • Professional Development

    • Promote From Within
    • Mentor Program
    • Access to Online Courses
    • Lunch and Learns
    • Internship Program
    • Leadership Training Program
    • Associate or Rotational Training Program
  • Diversity and Inclusion

    • Diversity, Equity, and Inclusion Program

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