PPR Specialist

University of Massachusetts - Westfield, MA

Full-time

Hybrid - Westfield, MA

Educational Services

About the position

The Public Provider Reimbursement (PPR) Specialist position at the University of Massachusetts Medical School is a full-time role within the Health Care Finance Solutions (HCFS) unit. This department is dedicated to conducting statewide business services for various health and human services agencies under the Executive Office of Health and Human Services (EOHHS) in Massachusetts. The primary goal of the PPR department is to maximize revenue for the Commonwealth by obtaining reimbursement from private, state, and federal resources for the costs associated with health care and related services provided by public institutions and community-based programs. As a PPR Specialist, you will be responsible for performing essential medical billing and claiming functions. This includes activities aimed at identifying and coordinating access to health care insurance and related benefits, as well as handling various administrative and clerical duties. The role requires a proactive approach to outreach, supporting clients and their families in completing and processing necessary applications and documents to determine and maintain health care coverage. You will also be involved in reviewing and analyzing data, maintaining spreadsheets and databases, and providing professional customer service to both internal and external clients. In addition to these responsibilities, the PPR Specialist will participate in continuous quality improvement initiatives and projects, ensuring compliance with state and federal regulations. The position requires the ability to work independently as well as collaboratively within a team, while also preserving the confidentiality of protected health information. This role is crucial in supporting the financial operations of the PPR department, which generates significant revenue for the Commonwealth through its various business services statewide.

Responsibilities

• Perform and assist with medical billing and claiming activities, including data entry to obtain reimbursement from liable payers for services provided by state-operated facilities and community-based programs.
• Meet all claiming, eligibility, and accounts receivable deadlines.
• Identify and coordinate access to Medicaid (MassHealth), Medicare, and commercial health care insurance, Social Security Administration, and other programs and benefits.
• Outreach to and support clients, families, guardians, and representatives to complete and process applications and documents required for health care coverage.
• Perform a broad spectrum of business services or specific services and focused activities.
• Review and analyze data, maintain and update spreadsheets, databases, and systems, and resolve discrepancies.
• Provide professional customer service to internal and external customers, responding to and following up on inquiries.
• Write, review, prepare, and maintain business documents including reports, contracts, manuals, procedures, and presentations.
• Participate in professional training and cross-training activities to enhance performance and skills.
• Engage in continuous quality improvement initiatives and projects.
• Foster compliance with state and federal rules and regulations.
• Work independently and as a team member and leader.
• Preserve confidential, protected health, and personally identifiable information and files.
• Perform other duties and special projects as required.

Requirements

• Associate's degree or equivalent experience.
• 1-3 years of related experience.
• Familiarity with database and spreadsheet applications such as Microsoft Office including Word, Excel, Teams, and One Drive.
• Ability to communicate effectively.
• Ability to adapt and change direction in response to changes in the business environment.

Nice-to-haves

• Medical billing or health care insurance experience.
• Knowledge of state and federal rules and regulations related to health care finance.
• Knowledge of state and federal information systems such as Meditech, MA21, MMIS, and MMARS.