Job Description Summary

MAJOR PURPOSEOversee enrollment and credentialing and special project related functions for MassHealth. ESSENTIAL JOB DUTIES• Supervise and direct the activities of staff as they pertain to 2 large enrollment/ revalidation/update teams• Check work queues in real time to assure completion of assigned work and daily productivity measures are met.• Reviews WFI work queue daily to review quality of those work items marked with a WFI status.• Assigns daily work and manages to established deadlines• Daily interactions with providers/customers and the client as required • Maintain compliance with related Service Level Agreements (SLAs)• Provides ongoing mentorship with staff and establishes development plans in Work Day • Provides input and feedback in the creation and maintenance of provider applications, other enrollment, credentialing, re-credentialing materials per the Contract• Accept and process MassHealth Provider applications and any credentialing and re-credentialing documentation from Providers within the timeframes set forth in the Contract• Supports the development and implementation of enrollment, credentialing, updating, and re-credentialing protocols, policies, and procedures per Contract specifications• Respond to all hard copy requests for Provider application packages in accordance with the EOHHS-approved protocols, policies, and procedures• Track for associated teams, within MMIS, all electronic Provider applications from an application request, through the application receipt and review process, to a final determination and notice of approval or denial• Ensure that the Provider applicant meets EOHHS enrollment criteria, per Contract specifications• Meets regularly with staff to review quality performance metrics and develops and implements corrective action and remedial training as necessary• Develop procedures within functional area to support special project implementation and ensure day to day coverage is adequate to demand• Stay current with local and national trends in PEC activities, including any requirements within the Affordable Care Act (ACA) and its corresponding regulations and sub-regulatory guidance• Collaboratively work with other departments (both internal and client), as well as large provider networks as needed for special projects/assignments • Manage and coordinate high-volume customer-facing e-mail inboxesEDUCATION REQUIRED• Associates degree from an accredited college or university or equivalent experienceREQUIRED KSAS• Previous experience successfully leading a provider enrollment and credentialing unit of similar size and complexity to the operations required under this contract.• Excellent written and verbal communication skills• Results oriented• The ability to perform comfortably in a fast-paced, deadline and detailed-oriented work environment• Experience and demonstrated skills with Quality Improvement Processes• Proficient with Microsoft Excel, Word, and PowerPoint

Job Summary

Essential Duties and Responsibilities:- Assign day to day enrolment and update tasks. - Monitor employee performance for compliance to established protocol (SLA).- Work closely with Quality Assurance (QA) and Documentation Management areas to ensure all providers are revalidated timely and accurately.- Effectively lead coach, train and counsel staff.- Research and respond to any escalated provider inquiries and requests in a timely, professional and informative manner.- Educate PEC specialists on updates and system changes to ensure synchronized process of data and documentation to meet regulatory guidelines and standards.Minimum Requirements:- Associate degree or equivalent combination of education, technical training or work experience considered in lieu of degree.- Minimum of two (2) years of related experience.- Ensure compliance with company Wage & Hour policy, including ensuring non-exempt employees get the rest & meal breaks.- Comply with all company required policies, procedures and processes including but not limited to required training.- Provides immediate supervision to a unit or group of employees, assigning tasks, checking work at frequent intervals, and maintaining schedules.- A portion of time is normally spent performing individual tasks related to the unit or sub-unit.- Generally supervises semi-skilled employees or a few individual professional contributors.- Works on issues of limited scope.- Follows established practices and procedures in analyzing situations or data from which answers can be readily obtained.- Monitors daily operations of a unit or sub-unit.- Requires full knowledge of own area of functional responsibility.- Frequently interacts with subordinate employees and functional peer groups.- Interaction normally requires the ability to gain cooperation of others, conducting presentations concerning specific projects or schedules.- Receives predetermined work assignments that are subject to a moderate level of control and review.- Directs subordinates to complete assignments using established guidelines, procedures and policies.

- Develop work schedules and assign duties to subordinates to ensure efficiency.- Evaluate subordinates' job performance and recommend appropriate personnel action.- Discuss job performance concerns with subordinates to identify causes and issues and works closely with the Human Capital department on resolving problems.- Identify training needs and development opportunities for subordinates.

MAXIMUS Introduction

Since 1975, Maximus has operated under its founding mission of Helping Government Serve the People, enabling citizens around the globe to successfully engage with their governments at all levels and across a variety of health and human services programs. Maximus delivers innovative business process management and technology solutions that contribute to improved outcomes for citizens and higher levels of productivity, accuracy, accountability and efficiency of government-sponsored programs. With more than 30,000 employees worldwide, Maximus is a proud partner to government agencies in the United States, Australia, Canada, Saudi Arabia, Singapore and the United Kingdom. For more information, visit https://www.maximus.com.

EEO Statement

EEO Statement: Active military service members, their spouses, and veteran candidates often embody the core competencies Maximus deems essential, and bring a resiliency and dependability that greatly enhances our workforce. We recognize your unique skills and experiences, and want to provide you with a career path that allows you to continue making a difference for our country. We’re proud of our connections to organizations dedicated to serving veterans and their families. If you are transitioning from military to civilian life, have prior service, are a retired veteran or a member of the National Guard or Reserves, or a spouse of an active military service member, we have challenging and rewarding career opportunities available for you. A committed and diverse workforce is our most important resource. Maximus is an Affirmative Action/Equal Opportunity Employer. Maximus provides equal employment opportunities to all qualified applicants without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, protected veteran status or disabled status.

Pay Transparency

Maximus compensation is based on various factors including but not limited to job location, a candidate's education, training, experience, expected quality and quantity of work, required travel (if any), external market and internal value analysis including seniority and merit systems, as well as internal pay alignment. Annual salary is just one component of Maximus's total compensation package. Other rewards may include short- and long-term incentives as well as program-specific awards. Additionally, Maximus provides a variety of benefits to employees, including health insurance coverage, life and disability insurance, a retirement savings plan, paid holidays and paid time off. Compensation ranges may differ based on contract value but will be commensurate with job duties and relevant work experience. An applicant's salary history will not be used in determining compensation. Maximus will comply with regulatory minimum wage rates and exempt salary thresholds in all instances.

Posted Max

USD $70,000.00/Yr.

Posted Min

USD $50,900.00/Yr.