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Manager-Provider Enrollment & Credentialing in Boston, MA at Maximus, Inc.

Date Posted: 7/23/2018

Job Snapshot

Job Description

-Establishes goals and objectives that support overall strategies and plans, develops, and schedules priorities and standards for achieving goals.
-Reviews and approves management, productivity, and financial reports and studies.
-Ensures that Call Center complies with all applicable requirements of the contract, state and federal regulations, and the terms and conditions of the contract.
-Reviews goals and objectives, guidelines, procedures, rules, and regulations; and, monitors compliance.
-Identifies issues and implements any necessary corrective actions to ensure consistent application of all laws, regulations, policies, and procedures.
-Represents MAXIMUS at business meetings, hearings, conferences, and seminars. The Ideal Candidate will Possess the Following Additional Education and Experience
  • Supervise and direct the activities of PEC and Revalidation functions
  • Maintain compliance with related Service Level Agreements (SLAs)
  • Create Provider applications, other enrollment, credentialing, re-credentialing materials per the Contract
  • Accept and process MassHealth Provider applications and any credentialing and re-credentialing documentation from Providers within the timeframes set forth in the Contract
  • Develop, gain EOHHS approval and implement, enrollment, credentialing, updating, and re-credentialing protocols, policies, and procedures per Contract specifications
  • Respond to all hard copy requests for Provider application packages in accordance with the EOHHS-approved protocols, policies, and procedures
  • Track, within MMIS, all electronic Provider applications from an application request, through the application receipt and review process, to a final determination and notice of approval or denial
  • Review all Provider application packages submitted per Contract specifications
  • Ensure that the Provider applicant meets EOHHS enrollment criteria, per Contract specifications
  • Identify all Provider applications that have disciplinary board actions and refer these applications to the EOHHS Provider Enrollment Committee once it is determined they meet all other enrollment criteria
  • Coordinate and administer the Provider Review Committee process including preparation, dissemination, facilitation and post meeting follow-up activities in accordance with EOHHS approved procedures
  • Maintain a directory of those EOHHS staff, designated vendors or EOHHS agencies which shall be sent the weekly Provider enrollment and disenrollment reports as described within the Provider Contract
  • Draft, gain EOHHS approval and implement multidimensional quality control procedures and standards to apply to the Provider application process to ensure that the processes adhere to quality control procedures and standards set forth by EOHHS
  • Perform imaging requirements set forth by EOHHS throughout the application process consistent with the approved MMIS imaging format, distinguishing between new Provider enrollment related documents and updates to existing provider files
  • Work closely with EOHHS managers; attend weekly meetings at the EOHHS Central Office
  • Stay current with local and national trends in PEC activities, including any requirements within the Affordable Care Act (ACA) and its corresponding regulations and sub-regulatory guidance
EEO Statement EEO Statement: Active military service members, their spouses, and veteran candidates often embody the core competencies MAXIMUS deems essential, and bring a resiliency and dependability that greatly enhances our workforce. We recognize your unique skills and experiences, and want to provide you with a career path that allows you to continue making a difference for our country. We’re proud of our connections to organizations dedicated to serving veterans and their families. If you are transitioning from military to civilian life, have prior service, are a retired veteran or a member of the National Guard or Reserves, or a spouse of an active military service member, we have challenging and rewarding career opportunities available for you. A committed and diverse workforce is our most important resource. MAXIMUS is an Affirmative Action/Equal Opportunity Employer. MAXIMUS provides equal employment opportunities to all qualified applicants without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, protected veteran status or disabled status.