Suspense Analyst

MassHealth is seeking qualified professionals for the role of Suspense Analyst in the Provider Service and Relationship Office. The primary purpose of this position is to assist the Suspense Unit in Claims Operations with the research, review, and resolution of suspended claims. Incumbents of this position will be expected to understand MassHealth policy to ensure the polies and regulations are adhered to.  Ideal candidates will display exceptional decision-making skills and demonstrate the ability to successfully resolute claims.

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

• Responsible for reviewing, researching, pricing of suspended claims for Durable Medical Equipment and other program areas. 
• Review support document for suspended claims to determine accuracy.
• Enter onto Medicaid Management Information System (MMIS) the payment and/or denial decisions for the suspended claims to ensure proper payment/denial from consultants or other program areas.
• Maintain current knowledge of provider billing and program regulations.
• Access MMIS online in order to analyze data, to determine the appropriateness of payment, and to release claims for payment or denial when necessary.
• Assist with the keying of resolved suspect duplicate claims and void transactions.
• Conduct an online MMIS quality-control review of 10% of worked claims to ensure accuracy.
• Recommend updates to written instructions based upon policy changes.
• Research, identify, report, and correct discrepancies on the reference file as needed.
• Perform and complete other duties and responsibilities as requested.

Preferred Qualifications:

• Ability to understand, explain and apply the laws, rules, regulations, policies, procedures, etc., governing assigned unit activities.
• Ability to analyze and determine the applicability of data, to draw conclusions and make appropriate recommendations.
• Ability to gather information by examining records and documents and by questioning individuals.
• Ability to assemble items of information in accordance with established procedures.
• Ability to determine proper format and procedure for assembling items of information.
• Ability to maintain accurate records.
• Ability to prepare and use charts, graphs and tables.
• Ability to prepare general reports.
• Ability to write concisely to express thoughts clearly and to develop ideas in logical sequence.
• Ability to follow written and oral instructions.
• Ability to give written and oral instructions in a precise, understandable manner.
• Ability to communicate effectively in oral expression.
• Ability to establish rapport with others.
• Ability to establish and maintain harmonious working relationships with others.
• Ability to deal tactfully with others.
• Ability to adjust to varying or changing situations to meet emergency or changing program requirements.
• Ability to exercise sound judgment.
• Ability to exercise discretion in handling confidential information.

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:

MassHealth, the Commonwealth's Medicaid program, provides health care benefits to certain low and medium-income Massachusetts residents.  As an innovative national leader, the Commonwealth's Medicaid program offers the opportunity to work with state-of-the-art technologies in a cutting-edge, fast-paced, call center environment. Selected applicants will have exceptional customer service, communications, and analytical skills.  We offer a unique opportunity to serve, and to make a positive contribution to our members.

The mission of MassHealth is to improve the health outcomes of our diverse members, their families and their communities by providing access to integrated health care services that sustainably promote 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.

MINIMUM ENTRANCE REQUIREMENTS: Applicants must have at least (A) two 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, or (B) any equivalent combination of the required experience and the substitutions below.

Substitutions:

I. A Bachelor's or higher degree with a major in business administration, business management or public administration may be substituted for the required experience. *

II. 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 experience.*

*Education toward such a degree will be prorated on the basis of the proportion of the requirements actually completed.

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.