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SNR PEC Specialist in Boston, MA at Maximus, Inc.

Date Posted: 10/15/2018

Job Snapshot

  • Employee Type:
    Full-Time
  • Location:
    Boston, MA
  • Job Type:
  • Experience:
    Not Specified
  • Date Posted:
    10/15/2018

Job Description

The PEC Specialist Level II will be responsible for the enrollment and credentialing process for more complex MassHealth provider applications. This role will be responsible for the review and verification of these application files to ensure that they are fully compliant with MassHealth regulations and enrollment standards. This role will have direct contact with program managers and will need to effectively communicate enrollment processes and statuses of enrollment applications. The Ideal Candidate will Possess the Following Additional Education and Experience

Essential job duties

  • Perform credentialing and re-credentialing activities for prospective and current MassHealth providers according to established guidelines. Duties include; reviewing provider applications, applying policy and criteria based on provide type, performing source verifications and processing provider files. Ensures provider compliance in regards to licensing and sanction information with all accrediting organizations and regulatory agencies including; but not limited to BORIM, DPL, LEIE, CHIP, MCSIS, NPPES and EPLS.
  • Ability to process applications and updates to any of the provider types MAXIMUS has credentialing responsibilities over.
  • Maintain provider updates as requested, verifying data and entering information into NEWMMIS. Completes all documentation and data entry in a timely and accurate fashion.
  • Understand and follow regulation timeframes and procedural guidelines for processing applications, updates and disenrollment activities according to company and contract standards (SLAs).
  • Respond to all provider enrollment related inquiries and requests in a timely and thorough fashion. Maintain strong professional written and oral interactions with providers, persistently following up on missing enrollment information and required documentation to complete file.
  • Ability to create and maintain clear and concise documentation pertaining to interactions with providers and enrollment history.
  • Communicates to providers any regulations and certification changes that affect file maintenance or membership, obtaining necessary documentation from providers for processing.
  • Communicates provider problems, inquiries or issues that cannot be resolved independently through the appropriate channels for resolution.
  • Ability to research and create accurate timeline for escalated enrollment issues.
  • Ability to create and maintain at hoc reports related to initiatives
  • Ability to make determinations regarding applicable provider files and changes that needs to be elevated to Leadership or EOHHS review.
  • Work as a liaison between MAXIMUS, EOHHS operations and program staff as well as collaborate internally within different departments.
  • Represent PEC during upon request meetings with EOHHS and providers related to PEC work.
  • Ability to work closely with program mangers on complex credentialing requirements such as DME, Pharmacy, Nursing Homes.
  • Ability to handle impact assessment and interaction related to Change of Corporate Structures.
  • Share provider feedback to help bridge gaps in services and build strong alliances with client as well as providers.
  • Communicate improvements to enhance systems development and processing capabilities.
  • Perform other duties as assigned
  • Performs other duties as assigned by management.

Education required

  • Bachelor’s Degree from an accredited college or university or the equivalent combination of education and experience. 

REQUIRED KSAs

  • Experience working with MassHealth program provider services
  • Ability to read and interpret written information from a variety of sources
  • Ability to work well under pressure in a fast-paced, deadline orientated work environment.
  • Ability to manage multiple priorities.
  • Ability to communicate clearly and concisely.
  • Accuracy and attention to detail is a MUST.
  • Must have excellent interpersonal and written communication skills.
  • Strong customer service orientation. Ability to establish and maintain relationships, building trust and respect by consistently meeting and exceeding expectations.
  • Self-motivated with strong follow-through skills.
  • Ability to work effectively both independently and with others.
  • Proficiency in Microsoft Office applications and other as required.
  • Maintains confidentiality of all provider information and company documents.
  • Credentialing process and primary source verification knowledge.
  • Knowledge and/or experience reviewing provider applications.
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.