Current jobs related to Operations Support - Worcester - Central Mass Health LLC

  • Operations Support Specialist

    1 week ago

    Worcester, Massachusetts, United States Central Mass Health LLC Full time

    Job SummaryCentral Mass Health LLC is seeking a skilled Operations Support Specialist to join our team. This role will assist the Operations team in planning, directing, and coordinating the functions of the Operations department for a Medicare Advantage Health Plan.The ideal candidate will have a strong understanding of Medicare regulations and experience...

  • Process Engineer Core Support Operations Specialist

    6 days ago

    Worcester, Massachusetts, United States AbbVie Full time

    Job SummaryThe Process Engineer will apply scientific knowledge, engineering principles, and mathematical concepts to complete assignments within the Core Support Operations Area. This operations area supports Biologics manufacturing through the production of Buffer and Media Solutions utilized in the Cell Culture and Purification operations, washing parts...

  • Interventional Radiology Technologist

    3 weeks ago

    Worcester, Massachusetts, United States HealthCare Support Full time

    Job Title: Interventional Radiology TechnologistWe are seeking a skilled Interventional Radiology Technologist to join our team at HealthCare Support. As a key member of our healthcare team, you will be responsible for providing high-quality patient care and assisting in the diagnosis and treatment of various medical conditions.Job Summary:The successful...

  • Diagnostic Medical Sonography Team Lead

    5 days ago

    Worcester, Massachusetts, United States HealthCare Support Full time

    Job Summary:HealthCare Support is seeking a highly skilled OBGYN Sonography Supervisor to oversee the daily operations of our Radiology Department. As a key member of our team, you will be responsible for supervising assigned personnel, ensuring the highest quality patient care, and maintaining accreditation and state inspection processes.Key...

  • Ultrasound Supervisor

    2 weeks ago

    Worcester, Massachusetts, United States HealthCare Support Full time

    OBGYN Sonography Supervisor Job DescriptionHealthCare Support is seeking a highly skilled OBGYN Sonography Supervisor to lead our radiology team in Worcester, MA. As a key member of our healthcare team, you will be responsible for overseeing the technical and supervisory aspects of ultrasound operations.Key Responsibilities:Supervise and mentor assigned...

  • IT Support Specialist

    4 weeks ago

    Worcester, Massachusetts, United States Mirick O'Connell Full time

    IT Support Specialist Opportunity at Mirick O'ConnellWe are seeking an experienced IT professional to join our team at Mirick O'Connell, a leading Massachusetts law firm. As an IT Support Specialist, you will provide technical support to our three offices, ensuring seamless operations and excellent service to our clients.Key Responsibilities:Provide...

  • IT Support Specialist

    4 weeks ago

    Worcester, Massachusetts, United States Mirick O'Connell Full time

    We are seeking an experienced IT professional to provide support to our three offices in Massachusetts. As an IT Support Specialist at Mirick O'Connell, you will be part of a collaborative team that values growth opportunities. Your primary responsibility will be to provide technical assistance to our staff, ensuring seamless operation of our computer...

  • IT Support Specialist

    1 week ago

    Worcester, Massachusetts, United States Paragus Strategic IT Full time

    Job SummaryWe are seeking a highly skilled and experienced IT Support Specialist to join our team at Paragus Strategic IT. As a key member of our support team, you will be responsible for providing exceptional customer service to our clients, ensuring their technical issues are resolved efficiently and effectively.Key Responsibilities:Manage and resolve...

  • Accounting Support Specialist

    5 days ago

    Worcester, Massachusetts, United States Seven Hills Foundation Full time

    Job Summary:As an Accounting Support Specialist at the Seven Hills Foundation, you will provide administrative support to the Accounting Department. This role involves working under the direct supervision of the Chief Financial Officer and the Controller. Your primary responsibilities will include carrying out all tasks professionally and efficiently, as...

  • IT Support Specialist

    4 weeks ago

    Worcester, Massachusetts, United States Veterans Inc Full time

    Job Title: IT Specialist - Per DiemAt Veterans Inc., we are seeking a highly skilled IT Specialist to join our team on a per diem basis. As an IT Specialist, you will play a critical role in supporting and maintaining our computer systems, desktops, and peripherals.Key Responsibilities:Install, diagnose, repair, maintain, and upgrade all hardware and...

  • Senior IT Support Specialist

    1 month ago

    Worcester, Massachusetts, United States Machado Full time

    Job SummaryWe are seeking a highly skilled Senior IT Support Engineer to join our team at Machado. As a key member of our IT Support department, you will be responsible for providing advanced technical support to our clients and ensuring the smooth operation of our IT systems.Key Responsibilities:Respond to escalated tickets via phone or email and assist...

  • IT Support Specialist

    4 weeks ago

    Worcester, Massachusetts, United States Veterans Inc. Full time

    Job Title: IT Specialist- Per DiemAbout the Role:We are seeking a highly skilled IT Specialist to join our team at Veterans Inc. as a Per Diem employee. As an IT Specialist, you will be responsible for providing technical support and maintenance for our computer systems, desktops, peripherals, and cell phones.Key Responsibilities:Install, diagnose, repair,...

  • Support Professional

    2 weeks ago

    Worcester, Massachusetts, United States The Arc of Opportunity Full time

    Job SummaryThe Direct Support Professional provides essential support to individuals with intellectual and developmental disabilities in a residential program setting. This role involves providing light to medium maintenance and domestic functions, including personal care needs, cleaning, laundry, cooking, and grounds keeping duties as assigned.The ideal...

  • Technical Support Specialist

    4 weeks ago

    Worcester, Massachusetts, United States HERE Technologies Full time

    Job Title: Technical Support SpecialistWe are seeking a skilled Technical Support Specialist to join our Capture Enablement Team within the Spatial Data Analytics & Engineering department at HERE Technologies.About the Role:This is an exciting opportunity to work with a dynamic team responsible for supporting the technical infrastructure involved in...

  • Clinical Support Associate

    2 months ago

    Worcester, Massachusetts, United States Tufts University Full time

    About the RoleWe are seeking a highly skilled and compassionate Veterinary Assistant to join our team at Tufts University's Community Veterinary Clinic. As a key member of our clinical staff, you will play a vital role in providing exceptional patient care and supporting the educational mission of our veterinary program.Key ResponsibilitiesPatient Care and...

  • Warehouse Support Specialist

    1 month ago

    Worcester, Massachusetts, United States Imperial Full time

    Job SummaryWe are seeking a highly motivated and detail-oriented Warehouse Support Specialist to join our team at Imperial. As a key member of our production team, you will play a vital role in ensuring the smooth operation of our warehouse and production facilities.Key ResponsibilitiesProvide support to production teams by ensuring they have the necessary...

  • Technical Support Specialist

    1 week ago

    Worcester, Massachusetts, United States HERE Technologies Full time

    About the Role:We are seeking a skilled Technical Support Specialist to join our Capture Enablement Team within the Spatial Data Analytics & Engineering (SDE) department. As a key member of our team, you will be responsible for providing first-level helpdesk support to remote APAC users encountering problems with our data capture systems.Your Key...

  • Medical Support Specialist

    6 days ago

    Worcester, Massachusetts, United States UMass Memorial Health Care Full time

    At UMass Memorial Health Care, we are seeking a skilled Medical Support Specialist to join our team. As a Medical Support Specialist, you will play a vital role in ensuring the smooth operation of our healthcare facilities. Your primary responsibilities will include: Escorting patients to examination rooms and recording vital signs such as blood pressure,...

  • Inbound Support Specialist

    2 weeks ago

    Worcester, Massachusetts, United States Imperial Full time

    Job SummaryWe are seeking a highly motivated and detail-oriented Inbound Support Associate to join our team at Imperial. As a key member of our production team, you will play a vital role in ensuring the smooth operation of our warehouse and maintaining customer satisfaction.Key ResponsibilitiesProvide support to production teams by ensuring they have the...

  • Senior IT Support Specialist

    2 weeks ago

    Worcester, Massachusetts, United States Machado Consulting Full time

    Job OverviewMachado Consulting is seeking a highly skilled Senior IT Support Engineer to join our team. As a key member of our IT Support department, you will be responsible for providing exceptional technical support to our clients and internal teams.Key ResponsibilitiesRespond to escalated tickets via phone or email and assist IT Support Technicians with...

Operations Support

4 months ago

Worcester, United States Central Mass Health LLC Full time
Job DescriptionJob DescriptionDescription:

Mass Advantage is a Medicare Advantage health plan, located in Worcester, MA. We are affiliated with the largest health care system in Central Massachusetts, UMass Memorial Health. They are the clinical partner of the University of Massachusetts Chan Medical School, with access to the latest technology, research and clinical trials.


We are seeking a Operations Support position to assist the Operations team. This person will assist with the planning, directing, monitoring, and coordinating the functions of Operations department for a Medicare Advantage Health Plan to include, claims, vendor management, member services, enrollment and member experience directly, indirectly or through vendor management. In addition, the Operations Support position will direct daily operational functions and large-scale projects to ensure the timely and accurate completion of all functions and tasks. The Operation Support position will also direct the preparation of departmental reporting, analyze and interprets all reported information and make recommendations to the COO based on the analysis. Accomplishes this by performing the following duties:

  • Under general supervision, coordinates and/or assists with all delegated activities to ensure compliance with state, federal, NCQA, and Mass Advantage requirements, such as performing analysis of annual due diligence audits and monitoring delegated activities.
  • Coordinates annual operational audits to include scheduling audits; accurately completing delegation audit tool; reporting outcomes to management; and required follow-up (e.g., additional mailings, obtaining signature pages, and arranging annual re-audit).
  • Monitors post-audit delegated activities to ensure compliance requirements are met. Examples include tracking receipt of and monitoring quarterly/yearly reports from delegated entities and assisting with development and implementation of Corrective Action Plans as non-compliant issues are identified.
  • Produces monthly scorecards to monitor compliance of Delegation Oversight activities and delegate performance metrics.
  • Responsible for volume / production planning, tool development / refinement, processing of captured forms, analysis of capture rates, analysis of revenue recovered, payment process and export of data to support applicable departments.
  • Performs analysis and strategy development and implementation; obtains data, verifies validity of data, and analyzes data as required.
  • Leads and directs the department toward operations, procedures, and policies which assure consistent, long-term accomplishment of overall departmental objectives.
  • Supports the operational performance of claims payment accuracy, manages tracking and monitoring of open tickets and issues with vendor through completion.
  • Provides regular monitoring and reporting of Key Performance Indicators (KPIs) and establish best practice claims payment methodology based on latest CMS claims payment rules, coordinate with various staff to establish best practices across all operational areas.
  • Conducts root cause analysis on systemic issues and formulate action plan to avoid incorrect payment to include review of contracts, Medicare claims payment rules, internal system and beneficiary impact.
  • Supports written reports for State and/or Federal agencies regarding inquiries into provider disputes, non-payment of claims, complaints or Complaint Tracking Module (CTMs).
  • Prepare comprehensive reports, making recommendations to correct deficiencies and practice or process improvements.
  • Identifies trends and issues across the operational environment to deliver seamless member experience.


Requirements:

Education and/or Experience

Bachelor's degree (B. A.) from four-year college or university; or five years related experience and/or training; or equivalent combination of education and experience.


Other Qualifications

  • At least 5 years previous experience in Operations of a Managed Care and/or Medicare Advantage Plan preferred.
  • Expert knowledge of Medicare regulations for Operational functions within a Health Plan.