General Summary of Position
The Public Provider Reimbursement (PPR) Department within the Center for Health Care Financing conducts statewide business services for several health and human services agencies of the Executive Office of Health and Human Services (EOHHS) to maximize revenue for the Commonwealth of Massachusetts. Revenue is obtained from private, state and federal resources to reimburse the Commonwealth for the costs of health care and related services provided by public institutions and community-based programs. The PPR Specialist is responsible for performing medical billing and claiming functions, activities to identify and coordinate access to health care insurance and related benefits, and administrative and clerical duties.
PPR produces over one billion in gross charges to liable payers and generates over $700 million in net revenue to the Commonwealth. PPR conducts various business services statewide for 12 health and human services agencies and more than 20 public facilities that include hospitals, mental health centers and clinics, intermediate care and skilled nursing facilities, and various community-based services. Community-based services include Home and Community-based Waivers, Residential Rehabilitation Option and Targeted Case Management programs. The Revenue Operations Specialist will work closely with PPR staff and collaborate with the staff of EOHHS health and human services agencies that may include the Department of Developmental Services, Department of Mental Health, the Department of Public Health, the Department of Youth Services, the Division of Health Care Finance and Policy, the Executive Office of Elder Affairs, the Massachusetts Commission for the Blind, the Massachusetts Commission for the Deaf and Hard of Hearing, the Massachusetts Rehabilitation Commission, the Office of Medicaid, and the Chelsea and Holyoke Soldiers’ Homes.
This position performs work for the Central and Western MA Inpatient Facility and Community Services for the Department of Mental Health.
A successful candidate will possess: