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Provider Review Committee (PRC) Coordinator in Boston, MA at Maximus, Inc.

Date Posted: 7/4/2018

Job Snapshot

  • Employee Type:
  • Location:
    Boston, MA
  • Job Type:
  • Experience:
    Not Specified
  • Date Posted:

Job Description

The PRC Coordinator supports the Provider Review Committee in its efforts to ensure that all MassHealth providers meet and maintain established guidelines for enrollment in the network. This position is responsible for researching and collecting documentation on both current providers as well as prospective providers that have been referred to the Coordinator for further investigation and/or review. Reporting to the Provider and Enrollment Credentialing Manager, this role is integral in coordinating all facets of the PRC monthly meetin

  • Coordinates and administers all facets of the Provider Review Committee process including; preparation, dissemination, facilitation and post meeting follow-up activities in accordance with already established guidelines and procedures.
  • Prepares case reports for committee members; finalizing the PRC Case Evaluation Summary Form, developing the PRC Meeting Agenda Page, and compiling information packets for all attendees.
  • Develops PRC files by conducting thorough research and accurately recording information gathered during the discovery process.
  • Disseminates relevant and comprehensive information regarding the provider during PRC meetings to ensure that committee members have a clear and concise understanding of the case including but not limited to; relevant provider history and licensing status, practice sites, potential impact on MassHealth members and other internal documentation or critical information.
  • Researches and outreaches with providers when needed to obtain further case and supporting information including; compliance letters that substantiate adherence to conditions, certificate of completion of CME's, monitoring reports and other required information.
  • Assures that provider outcomes and all follow up steps noted during the PRC meeting are documented and that all follow up tasks are completed in a timely fashion. This may include, but is not limited to, completing the PRC Summary Report, following up on any decisions or recommendations made during the meeting, drafting and disseminating PRC notification letters and documentation in the provider's electronic file.
  • Performs other duties, projects or special assignments as required; depending on departmental needs and priorities.
The Ideal Candidate will Possess the Following Additional Education and Experience
  • Bachelor's Degree from an accredited college or university or the equivalent combination of education and experience.
  • Ability to communicate in writing clearly, thoroughly documenting and organizing files
  • Strong organizational and administrative skills, attention to detail, and the ability to follow through are essential Excellent critical thinking skills and the ability to comprehend complex technical topics and specialized information
  • Ability to verbally communicate in front of large groups clearly and concisely; Excellent communication skills to interact and present findings to team members and CST management and EOHHS
  • Ability to effectively build positive and productive relationships and achieve business results with and through others
  • Ability to exhibit excellent judgment and work independently and within teams to accomplish goals
  • Proficiency in Microsoft Office applications and others as required
  • Maintains confidentiality of all provider information and company documents
  • Experience with MassHealth knowledge of PEC regulations and requirements.
  • Knowledge of PEC policies and procedures
  • Excellent written and verbal communication skills
  • Ability to perform comfortably in a fast-paced, deadline and detailed-oriented work environment
  • Ability to successfully execute many complex tasks simultaneously
  • Ability to lead teams as well as work as a team member.
  • Travel to off-site meetings is required on a monthly basis
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.