Health Safety Net Customer Service Representative

The Health Safety Net (HSN) Customer Service Representative will provide quality Customer Service to HSN providers and the public as needed. The incumbent will provide timely responses to provider questions regarding HSN eligibility, HSN regulations, HSN policy, and HSN provider reimbursement calculation. The HSN Customer Service Representative will be expected to provide assistance to public inquiries on how HSN works, eligibility and where services may be obtained using HSN as required. In addition, they will perform claim analytics and statistics pertaining to payments and denials for both HSN and MassHealth, the Commonwealth's Medicaid program.

Duties and Responsibilities (these duties are a general summary and not all inclusive):

       Provide quality Customer Service to HSN providers and the public as needed. Excellent communication skills required.

       Provide timely response to questions regarding HSN eligibility, HSN regulations, HSN policy, and HSN provider reimbursement calculation.

       Perform analysis of HSN claim data to assist providers in following HSN claim processing procedures and billing guidance.

       Provide assistance to public inquiries on how HSN works, and where services may be obtained using HSN as required.

       Provide timely statistics on number and types of inquiries received by the HSN helpline to Helpdesk Supervisor and Operations Manager.

       Review and keep informed of any HSN Regulation changes, and payment rules.  Make recommendations to Helpdesk Supervisor, Operations Manager and HSN Policy group when said changes and payment rules are difficult for providers and public to interpret. 

       Keep informed of changes to MassHealth, Connector and other insurance so as to assist inquiries as they relate to HSN.

       Perform other administrative duties as assigned. 

Preferred Qualifications:

       A broad knowledge of health care billing and payment systems, health care delivery systems and health care coverage options available under Massachusetts law and under the Affordable Care Act

       Requires excellent analytical and communication skills to enable provision of quality Customer Service to HSN providers and the public as needed.

       Experience with billing 837 Institutional and/or 837 Professional claims as well as knowledge of the file structure.  Experience with a billing system such as Siemens, Meditech, Keane, AccuClaim, Epic, etc.) is preferred.

       Manage multiple projects simultaneously and to respond to changes in priorities in a flexible manner

       Knowledge of basic hospital and/or health care operations or administration.

       Experience with Microsoft Office

       Ability to work both independently and in teams

       Ability to communicate effectively both orally and in writing.

       Ability to solve problems; investigate and resolve data and analysis issues.

       Ability to follow oral and written instructions.

       Ability to exercise sound judgment.

       Ability to exercise discretion in handling confidential information.

       Ability to deal tactfully with others.

       Ability to establish and maintain harmonious working relationships with others.

       The ability to adjust to changing situations to meet urgency or changing program requirements.
 

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 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 ADA Reasonable Accommodation Request Form

For questions regarding this requisition, please contact the Executive Office of Health and Human Services Human Resources at 1-800-510-4122 and select option 4.

Applicants should upload a cover letter and resume for the Health Safety Net Customer Service Representative requisition.

First consideration will be given to those applicants that apply within the first 14 days.
MINIMUM ENTRANCE REQUIREMENTS:
Applicants must have at least (A) three years of full-time, or equivalent part-time, professional experience in business administration, health care planning or administration, public health policy or administration, human services policy analysis or administration or economics, the major duties of which include financial analysis of costs, expenses and revenue and/or the development, implementation and monitoring of financial reimbursement systems, or (B) any equivalent combination of the required experience and the substitutions below. 
Substitutions: 
I. A Bachelor's degree with a major in health care administration, hospital administration, public health or health services administration, accounting, business administration, business management, public policy, public administration or economics may be substituted for a maximum of two years of the required experience.* 
II. A Graduate degree with a major in health care administration, hospital administration, public health or health services administration, accounting, business administration, business management, public policy, public administration or economics may be substituted for the required experience. 
*Education toward such a degree will be prorated on the basis of the proportion of the requirements actually completed. 
SPECIAL REQUIREMENTS: None.

 

 

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!

 

 

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.