MassHealth Program Manager

Mass General Brigham•Somerville, MA

4d•Remote

About The Position

Mass General Brigham Health Plan is an exciting place to be within the healthcare industry. As a member of Mass General Brigham, we are at the forefront of transformation with one of the world’s leading integrated healthcare systems. Together, we are providing our members with innovative solutions centered on their health needs to expand access to seamless and affordable care and coverage. Our work centers on creating an exceptional member experience – a commitment that starts with our employees. Working with some of the most accomplished professionals in healthcare today, our employees have opportunities to learn and contribute expertise within a welcoming and supportive environment that embraces their unique and varied backgrounds, experiences, and skills. We are pleased to offer competitive salaries and a benefits package with flexible work options, career growth opportunities, and much more. Responsible for supporting the appeals and claims resolution process, ensuring timely submission and follow-up on appeals. Assists with gathering documentation, tracking case statuses, and coordinating communications between departments to ensure the accurate handling of claims This role supports the day-to-day administration and operations of the MassHealth line of business. Working under the guidance of leadership, this role coordinates regulatory reporting, operational processes, stakeholder communications, and governance activities to support compliance with contractual requirements and organizational objectives. The position maintains documentation, tracks deliverables and action items, facilitates communication among stakeholders, and assists with the execution of MassHealth-related initiatives. The role follows established policies, procedures, and priorities while escalating complex issues and recommendations to leadership.

Requirements

Bachelor's Degree required; experience can be considered in lieu of a degree
At least 3-5 years of experience in project or program management required
At least 1-2 years of experience with Medicaid, MassHealth, or government programs preferred
At least 1-2 years of experience managing reporting processes and compliance workflows preferred
Excellent interpersonal and communication skills, with the ability to engage and collaborate with staff at all levels.
Excellent project/program management skills, including planning, scheduling, budgeting, and risk management, with the ability to effectively coordinate and delegate tasks, manage timelines, and drive results.
Strong analytical and problem-solving abilities, with attention to detail and accuracy.
Effective communication and interpersonal skills, with the ability to manage relationships with diverse stakeholders.
Proficiency in Microsoft Office Suite (including SharePoint, Excel, PowerPoint, Teams, Copilot) and data management software.
Ability to work collaboratively in a team environment.

Responsibilities

Coordinate assigned MassHealth operational activities and initiatives by maintaining timelines, tracking deliverables, documenting progress, and following up with stakeholders to support the timely completion of work.
Prepare, compile, and submit routine MassHealth regulatory reports and contractual deliverables, including quarterly, semi-annual, annual, and ad hoc submissions, in accordance with established requirements and timelines.
Receive, track, and distribute MassHealth communications to appropriate stakeholders; monitor responses and follow-up activities; and escalate issues requiring management review or decision-making.
Coordinate governance, committee, and meeting activities by scheduling meetings, preparing materials, documenting meeting outcomes, maintaining action-item logs, and supporting follow-up activities.
Support MassHealth operational processes, including benefit and reimbursement updates, bulletin and transmittal tracking, redetermination activities, member assignment processes, provider enrollment coordination, PIDSL maintenance, practice closure activities, discharge tracking, and related system updates.
Maintain reporting calendars, submission schedules, templates, process documentation, and departmental records to support compliance with MassHealth contractual requirements.
Assist internal stakeholders in collecting information, monitoring operational activities, and coordinating follow-up actions related to quality, health equity, care management, member experience, provider operations, finance, community partner performance, and MGB ACO initiatives.
Maintain shared resources, systems access, and departmental tools, including OnBase, POSC, Virtual Gateway, SharePoint, Teams sites, reporting libraries, and reference materials.
Produce routine reports, maintain operational data and documentation, and support leadership in monitoring departmental performance and compliance activities.
Identify operational issues, process gaps, or delays and communicate findings to leadership for review and guidance.
Performs other duties as assigned
Complies with all policies and standards