Health Insurance Program Coordinator II - Enhanced Coordination of Benefits Unit - Hybrid
- Employer
- University of Massachusetts Medical School
- Location
- 529 Main Street
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- Administrative Jobs
- Institutional & Business Affairs, Human Resources & Employee Development, Program Administration, Technology, Analysts & Programming
- Employment Type
- Full Time
- Institution Type
- Four-Year Institution
Job Details
GENERAL SUMMARY OF POSITION:
Under the general direction of the Manager or designee, the Insurance Program Coordinator II is assigned to a specific hospital or program. This position will be responsible for traveling to alternate work stations at the hospital sites and working with hospital or program staff to obtain, investigate and manage cases. The Insurance Program Coordinator will seek to maximize benefits available in private and public programs in order to preserve MassHealth as payor of the last resort.
The Enhanced Coordination of Benefits Unit is responsible for coordinating insurance benefits for high cost, medically complex MassHealth or pending MassHealth members who have access to commercial health insurance. The goal of the program is to ensure that MassHealth is the payor of last resort.
ResponsibilitiesMAJOR RESPONSIBILITIES:
- Consult with Patient Financial Counselors, Social Workers and Case Managers at hospitals to investigate referrals based on the patient’s current and prospective medical needs.
- Identify, evaluate, and coordinate health care benefits including rehabilitative and pharmacy services with Commercial Insurers for referrals received both internally and externally.
- Review family/social dynamics of the MassHealth member and investigate to determine availability or access to commercial health insurance, Premium Assistance and other State and Federal programs for which they may qualify.
- Educate members and families on commercial health insurance coverage based on their summary plan descriptions and explain how their MassHealth benefits work in conjunction with private health insurance.
- Analyze clinical, demographic and claims data to identify current and potential high utilizers of healthcare.
- Ensure that services provided maximize all payment sources that are available to the member while maintaining MassHealth as the payor of last resort.
- Interact with Mass Health members, providers, families, MassHealth staff, Center staff and insurers to manage health care benefits as they relates to the member’s plan of care.
- Document and track all information associated with a case and report MassHealth cost savings and provider revenue enhancement based on service costs deferred to other Insurers.
- Provide ongoing education to health care providers relating to MassHealth and Commercial Insurance regulations.
- Make appropriate referrals to various MassHealth units such as TPL Identification, MassHealth Standard and CommonHealth Premium Assistance, Disability Evaluation Services, and Community Case Management, and coordinate functions as required.
- Assist MassHealth member in accessing all available public programs for which they may qualify.
- Perform all other duties as assigned.
REQUIRED QUALIFICATIONS:
- Bachelor’s degree in Health Care Administration or equivalent Case Management or Insurance Coordination experience.
- 5 years relevant experience in a health care setting or legal setting.
- Expert knowledge of the insurance market and insurance coverage issues.
- Expert knowledge of complex medical needs.
- Working knowledge of rules and regulations of the Medicare, Commercial Insurance and Mass Health programs.
- Strong oral written communication skills.
- Effective Negotiating skills.
- Proficient in Word, Windows, Excel, Power Point, and FoxPro.
- Ability to travel in state as required
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PREFERRED QUALIFICATIONS:
- Case Management, Discharge Planning or Case Management certification a plus.
Organization
Realize Your Opportunities – A Career at UMASS Medical School
Inside Workings at UMASS Medical School
The University of Massachusetts Medical School (UMMS), the Commonwealth's only public medical school, is proud of our role in serving the people of Massachusetts. Although, its the inside workings of UMMS that makes the difference.
Mission and Culture
- We’re serious about our mission and about our people.
- Real World Impact - Our people get excited about our mission of real-world impact in health sciences education, research and public service.
- International Prominence and New Opportunities - As this institution has grown to national – and international – prominence, we’ve found new opportunities to train tomorrow’s physicians, nurses and scientists, discover causes of and cures for disease and help improve the quality of health care.
- Deep Commitment - With our clinical partner, UMass Memorial Health Care, and our other teaching affiliates, we share a deep commitment to national distinction in patient care.
- Valued Partnerships – UMMS partners with Commonwealth Medicine, the health care consulting arm of UMMS. Also, UMMS partners with MassBiologics in scientific collaborations, technology management and creating partnerships for the development of products for the benefit of patients. These valued partnerships help us to provide services and programs to help meet our needs at UMMS and the public.
- Proud Contributors - People at UMMS enjoy the feeling of going to work every day knowing what they do is truly important and worthwhile.
- Complementary and Inseparable - These varied parts of our mission and culture are complementary and inseparable.
Careers
UMMS, the state’s first and only public academic health sciences center, educates physicians, scientists and advanced practice nurses to heal, discover, teach and care, with compassion. UMMS is a world-class institution with opportunities to match. 
Competitive Compensation – UMMS offers salaries that are competitive with Worcester-area employers. When combined with our generous benefits, perks, and paid time off, many job seekers are surprised to find a total rewards package that matches or exceeds their current situation.
Targeted Hiring Process – At UMMS, there are actually multiple hiring processes for different segments of our workforce. In nearly all cases, UMMS hiring process is decentralized, with qualified candidates screened and referred to an academic officer or manager with hiring authority.
24/7 Access to Employment Opportunities – iCIMS is our online job search and application system. iCIMS is available 24/7 to provide you with a convenient and up-to-date view of the available employment opportunities across our campuses. Updates are made daily and include all faculty and non-faculty position listings from every school and department within the UMMS. When you identify a position you are interested in and qualified for, apply online. New opportunities become available frequently so it pays to check back often!
Benefits
With outstanding benefits, competitive pay, extensive learning opportunities, and a stimulating and attractive work environment, UMMS may be exactly the employer you’ve been looking for.
• Superior Benefits - UMMS offers a wide range of benefits and perks that invite comparison with the best employers in the Worcester area – and with academic institutions anywhere. UMMS provides superior medical and dental coverage for you and your family, fully funded retirement plans, generous time off, a Tuition Assistance Plan – and much more.
• People Centered - UMMS is an employer, but it is also a community. Its comprehensive medical and dental benefits, retirement plans, and even paid holidays reflect an institution built around people, with a deep respect for their differences and needs.
• Commitment to Healthy Living - UMMS provides resources to help you balance work and life and encourages healthy living through great programs and discounts for fitness, physical activity, weight management, nutritional counseling and general wellness available through our health insurance plans.
• Breadth of Offerings - Above all, the breadth of UMMS offerings set the School apart and makes it an environment favored by all sorts of smart, career-savvy people.
Apply for a Job
As an equal opportunity and affirmative action employer, UMMS recognizes the power of a diverse community and encourages applications from individuals with varied experiences, perspectives and backgrounds.
Online - To view all job opportunities and apply online, visit www.umassmed.edu/hr and click on the “Careers” tab.
Start Now and Realize Your Opportunities!
A History of Making Vital Improvements - UMASS Medical School Milestones
1962: Legislation establishes University of Massachusetts Medical School
1970: First medical students begin classes in Shaw Building
1974: First class graduates 16 MDs
1979: PhD program begins
1986: Graduate School of Nursing opens
1986: PhD program becomes Graduate School of Biomedical Sciences
1994: Graduate School of Nursing initiates PhD program
1998: UMass Clinical System and Memorial Health Care merge to form UMass Memorial Health Care
2001: Lazare Research Building opens
2002: Campus Modernization begins on the University Campus
2004: Graduate Entry Pathway Program established at the Graduate School of Nursing
2005: PhD Program in Clinical & Population Health Research established at the Graduate School of Biomedical Sciences
2005: Massachusetts Biologic Laboratories opens new manufacturing and filling facility in Mattapan
2006: Craig Mello, PhD, Blais University Chair in Molecular Medicine and Howard Hughes Medical Institute Investigator, is awarded the Medical School's first Nobel Prize. Dr. Mello shared the 2006 Nobel Prize in Physiology or Medicine with Andrew Fire, PhD, of Stanford University, for their discoveries related to RNA interference.
2007: Michael F. Collins, MD, is named chancellor and Terence R. Flotte, MD, is named dean of the School of Medicine.
2009: Groundbreaking for the Albert Sherman Center, a 500,000-square-foot research and education facility slated for completion in 2012.
2010: Ambulatory Care Center opens
2012: The Albert Sherman Center, a 500,000-square-foot research and education facility, completed and opens
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