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Paralegal

• Under the general direction of the Specialty Programs Unit Manager, serve as a resource to the Center for Healthcare Financing (CHCF) staff primarily in matters concerning estate recovery
• Ensure the integrity of collection outcomes, according to federal and state estate recovery regulations
• Refine and enhance current operations, implementing methods to identify new cases, verify claims and recover payments paid by Medicaid or other state funded programs
• Research, maintain and understand compilation of all Federal and State statutes and regulations pertaining to Third Party and Estate Recovery
• Maintain an assigned caseload following established protocols
• Identify benefits paid by Medicaid and calculate total value to be recovered in each case
• Represent the best interest of the Medicaid program consistent with CHCF goals and objectives
• Request and produce claims history printouts including all service reports from Medicaid history databases
• Investigate and document all case related matters and relevant financial and medical history to support claims against probate estates or third party settlements
• Provide training to support staff and maintain/update Recovery training manual
• Maintain all case records as required for established time periods
• Communicate and collaborate with probate courts, attorneys, hospitals, insurance companies and other relevant entities
• Conduct legal research using public databases and web applications and prepare legal memoranda for referral to Medicaid EHS legal department
• Research record of ownership and title of real estate at the Registry of Deeds
• Perform other job related duties as required or assigned

Paralegal - Case Specialist II, Estate Recovery Program

Financial Planning and Analysis

• The Financial Analyst will be responsible for conducting financial analysis, budgeting and planning, and the creation and presentation of financial statements, reports, and revenues, and reporting and metrics functions.
• The position will provide information to the leadership team on cost savings, cost analysis, financial management, financial metrics, and financial improvement opportunities.
• The Financial Analyst will also perform backfill support for data analysis needs.
• The Financial Analyst will report to the Director, Finance.
• Assist the Director, Finance in monitoring and analyzing financial accounts on a monthly, quarterly, and annual basis.
• Support the Finance leadership team in providing market and margin analysis, pricing models, and cost development support services.
• Analyze financial information using queries, spreadsheets, databases and other reporting tools for trend analysis, forecasting, and financial ratios.
• Analyze trends, make financial projections, and assess financial risk.
• Produce financial reports for management, as needed or requested, including income statements, cash flow statements, and balance sheets.
• Conduct in-depth analysis of program data and performing computations with a high degree of independence.
• Collect, extract, analyze, and manage financial information.
• Ensure accuracy of reports by reviewing data and resolving discrepancies internally for assigned reports.
• Prepare reports and projections based on financial data, consolidating for leadership team.
• Create and submit journal entries and reports.
• Track and analyze revenue data.
• Participate in project meetings related to financial analysis, data analysis, and management.
• Support internal dashboards and reporting, including the review of dashboards created by other team members.
• Review and support DCS finance group team members as needed.
• Review and monitor compliance with the federal and state regulations.

Financial Analyst

Data Analyst

• Develop and maintain data-driven financial, claim-related, and program performance reports for internal management and external client audiences.
• Perform compliance reviews of program data, including claims, payments, payment or costs settlement report data for quality assurance and program integrity purposes.
• Analyze large, complex data sets to quantify and resolve problems, inform management decisions, monitor program changes and their impact, and communicate important information for internal management and external clients.
• Apply knowledge of program systems to identify and troubleshoot issues, participate in testing of software changes and assist clients and external users to effectively use the program’s systems and applications.
• Assist in the design and maintenance of internal controls to ensure quality and accuracy of business unit’s work products.
• Compile and review claims, payments and/or other financial data for approval or distribution
• Identify and resolve any discrepancies, questions or outstanding issues related to claims, payments or other financial data for approval or distribution including coordination with internal staff, health plans, clients, or systems staff.
• Prepare financial/claims data for final submission and ensure the quality of the data is accurate and meets regulatory compliance, financial and/or other contractual requirements.
• Apply knowledge of state and federal program requirements, program guidelines and reimbursement methodologies in all aspects of work.
• Design and produce ad-hoc reports to meet internal management and client requests for data to inform decision-making and to fulfill public records requests.
• Complete and synthesize analysis of claims, payments and/other financial data to report to appropriate internal and external stakeholders.
• Utilize verbal and written communication skills to effectively communicate program information and explain requirements and methodology to various clients and external users of Umass Chan systems and applications.
• Complete tasks required for the preparation and conclusion of the program’s operational, financial or other contractual deadlines including set-up and maintenance of required claiming variables, notifications to clients and other stakeholders of deadlines, claim status, and actions needed.
• Preserve confidential, protected health and personally identifiable information and files.
• Perform related duties as needed and as assigned.

Healthcare Data Analyst

Program Manager

• Under the general direction of the Department Manager or designee, the Sr. Program Operations Specialist will be responsible for the categorization of time study data and review of expenditure and other data for the purpose of claim calculation and submission.
• Will work within the Federal Claiming unit that specializes in configuring technical solutions and providing expertise and resources to state government agencies for the purposes of seeking federal reimbursement for eligible expenditures and services. Currently this unit provides solutions and support to 23 programs in 9 states and over 50,000 end users.
• Note: Position is fully remote.
• Responsibilities Carefully evaluate and analyze RMTS data completed by clients to ensure compliance with program requirements.
• Promptly validate data with clients, as appropriate, to ensure accuracy of submitted information within time sensitive deadlines.
• Update internal knowledge database to continually refresh or improve performance and accuracy of work.
• Complete independent peer review of other RMTS program data to ensure categorization by peers aligns with internal processes and procedures.
• Collaborate with other team members and leverage team resources to categorize data consistently and timely.
• Provide constructive feedback as appropriate.
• Compile final RMTS results for client review and sign off, as required.
• Review and analyze expenditure and statistical data provided by clients to support claim and cost settlement calculations in accordance with internal processes and procedures.
• Participate in testing of system features/functions/bug fixes, including suggesting and identifying areas for functionality improvements.
• Keep abreast of any regulatory or program changes.

Senior Program Operations Specialist

Medical Director

• The Medical Director provides clinical leadership for the Disability Evaluation Services (DES) Program, under the supervision of the Senior Medical Director.
• As part of the DES senior leadership team, the Medical Director reviews disability regulations, directs internal clinical procedures and provides consultation to state policy makers.
• The Medical Director is responsible for supervising and/or overseeing the physician advisors and quality assurance consultants as well as ensuring compliance for contracted network consultative examination providers.
• Major Responsibilities: At the direction of the Senior Medical Director, provides clinical leadership for the disability evaluation process; Provides leadership for the disability process for Medicaid agencies and Public Employees Retirement Systems; Monitors productivity and provides oversight and clinical direction to DES clinicians, including Physician Advisors; Participates in creation of physician compensation models in conjunction with leadership team; Leads Internal Clinical Consultation Committees for MassHealth, OCA (Office of Clinical Affairs), and other Pension Retirement Contracts, for the handling and decision making of contested cases; Assists in formulating and implementing new business development strategies and marketing and sales efforts to achieve growth aligned with the strategic priorities of UMass Chan and ForHealth Consulting; Collaborates with DES clinical leadership in the interpretation of disability regulations; Participates in the review of regulation and policy changes impacting the disability evaluation process; Leads the development of clinical procedural standards and quality evaluations; Monitors and provides feedback to DES physicians and psychologists; Oversees DES quality management programs, including ongoing quality assurance, program evaluation initiatives, and performance goal management; Provides feedback to DES physicians and psychologists as well as other DES clinical staff regarding clinical policies and the outcomes of quality evaluations; Participates in the development and training for network providers and DES clinical staff, including physicians and psychologists; Advises DES staff on client issues involving sensitive medical information, adverse clinical findings, and safety issues; Directs contract compliance initiatives for DES contracted network physicians and psychologists; In conjunction with the Physician Network Manager, contributes to the recruitment and credentialing of contracted network physicians and psychologists; Provides feedback, quality assurance and disciplinary process of DES contracted network physicians and psychologists; Under the direction of the Senior Medical Director, oversees new projects and initiatives at DES for MassHealth or other clients, and explores new business opportunities for DES.

Paralegal - Case Specialist II, Estate Recovery Program

Financial Analyst

Healthcare Data Analyst

Senior Program Operations Specialist

Medical Director - Disability Evaluation Services (Remote)