Community Health Center Program Analyst

MassHealth is seeking qualified applicants for the position of Community Health Center Program Analyst. The Community Health Center Program Analyst will be responsible for coordinating the Community Health Center service lines, including all projects and initiatives in accordance with all relevant EOHHS and MassHealth program and provider regulations and delivery systems.

Duties and Responsibilities (these duties are a general summary and not all inclusive):

·       Coordinate and monitor the rate regulations and reimbursement policies for assigned programs to ensure effective operations and compliance with established standards.

·       Review and analyze utilization data for assigned programs in order to determine progress and effectiveness, make recommendations for changes in procedures, guidelines, etc. and devise methods of accomplishing the program objectives.

·       Provide technical assistance and advice to Agency personnel and others concerning assigned programs in order to exchange information, resolve problems and ensure compliance with established policies, procedures and standards.

·       Research cost data of assigned programs for the rate review process with the Center for Health Information Analysis (CHIA).

·       Implement annual coding updates, e.g., Current Procedural Terminology (CPT), Healthcare Common Procedure Coding System (level II) (HCPCS ) and International Classification of Diseases (ICD-10).

·       Respond to inquiries from Agency staff, members, external professional provider associations and others in order to provide policy guidance and interpretation of the regulations.

·       Performs related duties such as attending meetings, conferences, and provider training; maintaining records; and preparing reports.

·       Research Medicaid Management Information System (MMIS) claims history and other files to resolve inquiries for assigned programs.

·       Monitor the performance of contracted providers and applicable vendors to ensure compliance with MassHealth’s contract standards and goals.  

·       Coordinate with the Center for Health Information Analysis (CHIA), Budget, Purchasing Strategies staff and other reimbursement entities to ensure that appropriate methodologies and rates are established for services reimbursed by the MassHealth agency.

·       Working with team members to develop insightful display of data using visualization tools.

·       Assisting in the interpretation of data and providing the team with data-driven recommendations.

·       Prepare and disseminate quarterly Reconciliation Wrap APM Payments to key stakeholders.

·       Participate in a variety of MassHealth initiatives including health care reform, cost containment and payment reform initiatives.

·       Prepare and present formal recommendations to MassHealth executive team.

·       Respond to inquiries from Legislatures, advocates, contracted providers, members and CMS regarding regulations, policy interpretation and contract specifications.