Program Eligibility Coordinator

Location
Boston, Suffolk County / Charlestown, Suffolk County
Posted
Jun 09, 2014

Commonwealth Medicine (CWM) is the consulting division of UMass Medical School.  The CWM Center for Health Care Financing (CHCF) helps state and local governments, primarily in Massachusetts, identify opportunities to increase savings and reimbursements through federal and other third party sources, establish effective savings and reimbursement programs and capitalize on all possible revenue streams. We identify opportunities for our clients to increase services and reduce the net cost of delivery.

 

The SSI State Supplement Program (SSP) is a joint program of the Executive Office of Health and Human Services (EOHHS), the Department of Transitional Assistance (DTA), and the Mass Commission for the Blind (MCB).  The SSP provides state-funded supplemental payments to eligible aged, disabled and blind SSI recipients and to low income clients who are eligible for SSI but for income.  SSP eligibility is an eligibility factor for certain related benefits, including SNAP and MassHealth.

 

CHCF began administering the SSP on behalf of the Commonwealth of Massachusetts in April, 2012.  The implementation process is planned on an evolving multi-year schedule, comprising several phases of enhanced and additional operations.  Our responsibilities include program management and operations, eligibility determination, payment calculation and issuance, client services, outreach projects, program integrity, quality control and ongoing program development.   Program administration is dynamic, fast-paced, and continually progressing; success will require multi-tasking, internal and external collaboration, and the ability to meet deadlines and work under pressure.  

 

GENERAL SUMMARY OF POSITION: 

Under the general direction of the Director or designee, the Program Eligibility Coordinator leads benefit eligibility and determination assessments. The Program Eligibility Coordinator will assist in the eligibility activities related to benefit issuance to recipients in Massachusetts. The Program Eligibility Coordinator is responsible to review and research all demographic information that impacts recipient benefits, to process eligibility transactions and demographic changes, and to coordinate with customer service operations.

 

MAJOR RESPONSIBILITIES:

  • Complete comprehensive case reviews to determine benefit eligibility by researching, analyzing and validating data, applying knowledge of state and federal regulations.
  • Perform complex operational assignments requiring a high degree of independent judgment.
  • Work in coordination with the Client Services and Operations staff to troubleshoot escalated Client Services issues.
  • Represent the state at SSP hearings, providing a comprehensive explanation of the state determination based on state and federal regulations.
  • Coordinate appeal related matters with Division of Hearings, including but not limited to, creating evidence packets.
  • Compile operational reports, review outcomes and identify trends in support of program performance reporting.
  • Assist in the development policies and procedures to ensure quality and program compliance.
  • Assist in the planning, monitoring and deployment of new/changes of system functionality.
  • Assist in identifying potential quality assurance and system issues.
  • Analyze report data, identify trends and update senior staff.
  • Demonstrate the use of quality improvement in daily operations.
  • Participate in various analysis and special project assignments as assigned.
  • Maintain confidentiality of all business documents and correspondence per UMMS/CWM procedures and HIPAA regulations.
  • Comply with all health, safety and program regulations and requirements.
  • Perform other duties as required.


REQUIRED QUALIFICATIONS:

  • Bachelor’s degree in Business Administration, Management, Accounting or related field, or equivalent experience
  • 2 years of related business experience.
  • Ability to interpret state and federal laws and regulations.
  • Strong attention to detail.
  • Assist in the preparation of data and analysis of information as requested for reports.
  • Implement and manage tasks in accordance with program objectives.  
  • Demonstrated ability to handle confidential information and to exercise judgment and discretion.
  • Excellent oral and written communication skills.

 

PREFERRED QUALIFICATIONS:

  • Knowledge of State Health and Human Service programs
  • Knowledge of eligibility rules for State Supplemental Program
  • Knowledge of Social Security, Medicaid and Medicare programs, policies and procedures

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