MassHealth Program Manager

Site: Mass General Brigham Health Plan Holding Company Inc.

Mass General Brigham relies on a wide range of professionals including doctors nurses business people tech experts researchers and systems analysts to advance our mission. As a not-for-profit we support patient care research teaching and community service striving to provide exceptional care. We believe that high-performing teams drive groundbreaking medical discoveries and invite all applicants to join us and experience what it means to be part of Mass General Brigham.

Job Summary

Mass General Brigham Health Plan is an exciting place to be within the healthcare industry. As a member of Mass General Brigham we are at the forefront of transformation with one of the worlds leading integrated healthcare systems. Together we are providing our members with innovative solutions centered on their health needs to expand access to seamless and affordable care and coverage.

Our work centers on creating an exceptional member experience a commitment that starts with our employees. Working with some of the most accomplished professionals in healthcare today our employees have opportunities to learn and contribute expertise within a welcoming and supportive environment that embraces their unique and varied backgrounds experiences and skills.

We are pleased to offer competitive salaries and a benefits package with flexible work options career growth opportunities and much more.
Responsible for supporting the appeals and claims resolution process ensuring timely submission and follow-up on appeals. Assists with gathering documentation tracking case statuses and coordinating communications between departments to ensure the accurate handling of claims

This role supports the day-to-day administration and operations of the MassHealth line of business. Working under the guidance of leadership this role coordinates regulatory reporting operational processes stakeholder communications and governance activities to support compliance with contractual requirements and organizational objectives. The position maintains documentation tracks deliverables and action items facilitates communication among stakeholders and assists with the execution of MassHealth-related initiatives. The role follows established policies procedures and priorities while escalating complex issues and recommendations to leadership.

Essential Functions
-Coordinate assigned MassHealth operational activities and initiatives by maintaining timelines tracking deliverables documenting progress and following up with stakeholders to support the timely completion of work.
-Prepare compile and submit routine MassHealth regulatory reports and contractual deliverables including quarterly semi-annual annual and ad hoc submissions in accordance with established requirements and timelines.
-Receive track and distribute MassHealth communications to appropriate stakeholders; monitor responses and follow-up activities; and escalate issues requiring management review or decision-making.
-Coordinate governance committee and meeting activities by scheduling meetings preparing materials documenting meeting outcomes maintaining action-item logs and supporting follow-up activities.
-Support MassHealth operational processes including benefit and reimbursement updates bulletin and transmittal tracking redetermination activities member assignment processes provider enrollment coordination PIDSL maintenance practice closure activities discharge tracking and related system updates.
-Maintain reporting calendars submission schedules templates process documentation and departmental records to support compliance with -MassHealth contractual requirements.
-Assist internal stakeholders in collecting information monitoring operational activities and coordinating follow-up actions related to quality health equity care management member experience provider operations finance community partner performance and MGB ACO initiatives.
-Maintain shared resources systems access and departmental tools including OnBase POSC Virtual Gateway SharePoint Teams sites reporting libraries and reference materials.
-Produce routine reports maintain operational data and documentation and support leadership in monitoring departmental performance and compliance activities.
-Identify operational issues process gaps or delays and communicate findings to leadership for review and guidance.
-Performs other duties as assigned
-Complies with all policies and standards

Education

• Bachelors Degree required; experience can be considered in lieu of a degree

Experience

• At least 3-5 years of experience in project or program management required
• At least 1-2 years of experience with Medicaid MassHealth or government programs preferred
• At least 1-2 years of experience managing reporting processes and compliance workflows preferred

Knowledge Skills and Abilities

• Excellent interpersonal and communication skills with the ability to engage and collaborate with staff at all levels.
• Excellent project/program management skills including planning scheduling budgeting and risk management with the ability to effectively coordinate and delegate tasks manage timelines and drive results.
• Strong analytical and problem-solving abilities with attention to detail and accuracy.
• Effective communication and interpersonal skills with the ability to manage relationships with diverse stakeholders.
• Proficiency in Microsoft Office Suite (including SharePoint Excel PowerPoint Teams Copilot) and data management software.
• Ability to work collaboratively in a team environment.

Remote

399 Revolution Drive

40

Regular

Day (United States of America)

Pay Range

$63648.00 - $92570.40/Annual

Grade

6

At Mass General Brigham we believe in recognizing and rewarding the unique value each team member brings to our organization. Our approach to determining base pay is comprehensive and any offer extended will take into account your skills relevant experience if applicable education certifications and other essential factors. The base pay information provided offers an estimate based on the minimum job qualifications; however it does not encompass all elements contributing to your total compensation addition to competitive base pay we offer comprehensive benefits career advancement opportunities differentials premiums and bonuses as applicable and recognition programs designed to celebrate your contributions and support your professional growth. We invite you to apply and our Talent Acquisition team will provide an overview of your potential compensation and benefits package.

8925 Mass General Brigham Health Plan Holding Company Inc. is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race color religious creed national origin sex age gender identity disability sexual orientation military service genetic information and/or other status protected under law. We will ensure that all individuals with a disability are provided a reasonable accommodation to participate in the job application or interview process to perform essential job functions and to receive other benefits and privileges of employment. To ensure reasonable accommodation for individuals protected by Section 503 of the Rehabilitation Act of 1973 the Vietnam Veterans Readjustment Act of 1974 and Title I of the Americans with Disabilities Act of 1990 applicants who require accommodation in the job application process may contact Human Resources at .

Mass General Brigham Competency Framework