PPR Specialist
- Employer
- University of Massachusetts Medical School
- Location
- 60 Hodges Avenue
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- Employment Type
- Full Time
- Institution Type
- Four-Year Institution
Job Details
POSITION SUMMARY:
The Public Provider Reimbursement (PPR) Department withinHealth Care Finance Solutions (HCFS) unit conducts statewide business services for several health and human services agencies of the Executive Office of Health and Human Services (EOHHS) to maximize revenue for the Commonwealth of Massachusetts. Revenue is obtained from private, state and federal resources to reimburse the Commonwealth for the costs of health care and related services provided by public institutions and community-based programs. The PPR Specialist is responsible for performing medical billing and claiming functions, activities to identify and coordinate access to health care insurance and related benefits, and administrative and clerical duties.
Responsibilities
ESSENTIAL FUNCTIONS:
- Perform and assist with medical billing and claiming activities, including any data entry, to obtain from liable payers reimbursement for services provided by state-operated facilities and community-based programs.
- Meet all claiming, eligibility and accounts receivable deadlines.
- Identify and coordinate access to Medicaid (MassHealth), Medicare and commercial health care insurance, Social Security Administration and other programs and benefits.
- Outreach to, proactively support and work with clients, clients’ families, guardians and representatives to complete and process applications, forms and other documents required to determine, redetermine, validate, reinstate and maintain health care coverage and related benefits.
- Perform and assist with broad spectrum of business services or specific services and focused activities.
- Review and analyze data, maintain and update spreadsheets, databases and systems and resolve discrepancies.
- Provide internal and external customers with professional customer service including responding to and following up on inquiries.
- Write, review, prepare and maintain business documents including reports, contracts, manuals, procedures and presentations.
- Participate in professional training and cross-training activities to enhance performance and skills.
- Participate in continuous quality improvement initiatives and projects.Foster compliance with state and federal rules and regulations.
- Work independently and as a team member and leader.
- Preserve confidential, protected health and personally identifiable information and files.
- Perform other duties and special projects as required.
Qualifications
Required Qualifications:
- Associate’s degree or equivalent experience.
- 1-3 years of related experience
- Familiarity with database and spreadsheet applications such as Microsoft Office including Word, Excel, Teams and One Drive
- Ability to communicate effectively
- Ability to adapt and change direction in response to changes in the business environment.
Preferred Qualifications:
- Medical billing or health care insurance experience
- Knowledge of state and federal rules and regulations related to health care finance
- Knowledge of state and federal information systems such as Meditech, MA21, MMIS and MMARS
Additional Information
PPR produces over one billion in gross charges to liable payers and generates over $700 million in net revenue to the Commonwealth. PPR conducts various business services statewide for 12 health and human services agencies and more than 20 public facilities that include hospitals, mental health centers and clinics, intermediate care and skilled nursing facilities, and various community-based services. Community-based services include Home and Community-based Waivers, Residential Rehabilitation Option and Targeted Case Management programs. The Revenue Operations Specialist will work closely with PPR staff and collaborate with the staff of EOHHS health and human services agencies that may include the Department of Developmental Services, Department of Mental Health, the Department of Public Health, the Department of Youth Services, the Division of Health Care Finance and Policy, the Executive Office of Elder Affairs, the Massachusetts Commission for the Blind, the Massachusetts Commission for the Deaf and Hard of Hearing, the Massachusetts Rehabilitation Commission, the Office of Medicaid, and the Chelsea and Holyoke Soldiers’ Homes.
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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