MassHealth Program Manager

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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.

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 world’s 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 Mass Health 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 Mass Health-related initiatives. The role follows established policies, procedures, and priorities while escalating complex issues and recommendations to leadership.

• Coordinate assigned Mass Health 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 Mass Health 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 Mass Health communications to appropriate stakeholders; monitor responses and follow-up activities; and elevate 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 Mass Health 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 Mass Health contractual…