Program Operations Specialist

Under the general direction of the Department Manager or designee, the Program Operations Specialist will be responsible for providing technical support of specialized software applications utilized by clients.  This position will specialize in Random Moment Time Study software and data requirements.   The Program Operations Specialist will be required to prioritize tasks within time sensitive deadlines in a dynamic environment.

The Program Operations Specialist will work within the Federal Claiming unit that specializes in the configuration of technical solutions and provides expertise and resources to state governmental 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, supporting over 50,000 end users.

Note: Position is fully remote. Scheduled work hours for this position rotate between three shifts that can start as early as 7:00am and end as late as 7:30pm. Staff are expected to rotate shifts every two weeks.  The help desk is also open on some holidays.  Holiday hours worked will be compensated to use as accrued time on another scheduled day.

• Provide 1:1 training and support to customers with application features and functions. 
• Disseminate accurate program requirements and policies to customers.
• Promptly resolve end user programmatic and technical questions, providing appropriate solutions and assistance. 
• Escalate technical/system issues appropriately, including gathering and providing detailed documentation to support and explain the issues. 
• Perform various RMTS-related operational tasks in accordance with specific program requirements, internal procedures, and time sensitive deadlines.
• Monitor and manage end-user software access according to internal control procedures.
• Participate in testing of system features/functions/bug fixes, including suggesting and identifying areas for functionality improvements. 
• Collaborate with other team members and leverage team resources to continuously improve service delivery, performance and customer satisfaction.
• Keep abreast of any regulatory or program changes.

REQUIRED EDUCATION:

Bachelor's Level Degree or equivalent work experience

REQUIRED WORK EXPERIENCE:

• 1-3 years of related experience including but not limited to customer technical support, helpdesk support, program administration or coordination.
• Strong organizational skills
• Proficiency with essential Microsoft Office applications (Word, Excel, Outlook, Teams)
• Demonstrated ability to work independently or as team player to achieve objectives.
• Strong oral and written communication skills
• Exceptional customer service skills

PREFERRED WORK EXPERIENCE:

• Prior customer service focused work experience preferred
• Federal claiming experience
• Familiarity with Random Moment Time Study or other cost allocation tools.

About the Health Care Finance Solutions and School Based Claiming

The Health Care Finance Solutions (HCFS) is a part of ForHealth Consulting (ForHealth), the health care consulting division of UMass Medical School, Massachusetts’ only public medical school. As nationwide leaders in the development and implementation of health care reform, ForHealth and HCFS stay ahead of health care trends and help strategize and plan for changes that impact both health care delivery systems and patients on the local, state and national level.

HCFS helps state agencies identify opportunities to increase savings and reimbursements through federal and other third-party sources, establish effective savings and reimbursement programs, and capitalize on all possible revenue streams. At the same time, we identify opportunities for our clients to increase health care related services, reduce the net cost of delivery, and help ensure individuals receive the health and human service benefits to which they may be entitled.

About School Based Claiming (SBC)

Federal financial participation (FFP) is available through Title XIX and Title XXI of the Social Security Act to match expenditures by cities and towns, regional school districts and charter schools (collectively, Local Education Agencies (LEAs)) for the provision of medically necessary medical services provided to Medicaid-enrolled students.  Also eligible for FFP are the LEA costs associated with performing Medicaid administrative activities related to the delivery of services and with performing qualifying outreach activities.  Collectively, this program is referred to as the School-Based Medicaid Program.

The SBC unit at HCFS works closely with Massachusetts and other states to develop, implement, and manage various activities that support direct service or administrative activity claiming to the Medicaid program.  To that end, SBC develops, maintains, and supports solutions for states to compile, report and review eligible expenditures for Medicaid Administrative Claiming, Direct Service Cost Report Reconciliation and Settlement, Medicaid Eligibility Matching, Random Moment Time Studies or other equivalent allocation methods to support the identification of Medicaid related costs. With a deep knowledge of federal Medicaid regulations, SBC optimizes claiming opportunities, while ensuring compliance with all applicable state and federal rules.   Today, SBC supports over 50,000 users in 9 states. 

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