State of Massachusetts Program Integrity Analyst in Quincy, Massachusetts

The Program Integrity Analytics Manager is a subject matter expert in all MassHealth policies, procedures and regulations and supporting systems, MA-21, MMMIS, Cognos. The Manager will also act as a consultant and advisor to Senior Leaders at MassHealth to provide feedback on the issues and concerns identified which may entail a new MMIS edit, a regulation/policy change.

The Manager of Program Integrity Analytics oversees high-priority, inter-departmental projects including 1) restructuring of provider regulations, 2) identification and implementation of operational improvements, 3) identification and implementation of program integrity solutions, and 4) other urgent program integrity priorities. For each such initiative, the Manager works with the Director of Program Integrity Analytics and oversees a cross-functional team including representatives from MassHealth program, policy, legal, and IT units to develop work plans, generate innovative program integrity ideas, conduct analysis, and propose solutions to the MassHealth executive team. The Manager also engages with external stakeholders, MassHealth members, advocates, providers, and payors, as necessary to collect input and ensure policy objectives are implemented smoothly.

  1. Conduct analysis on medical claims data, provider cost reports, and other sources to identify and prioritize opportunities for improvement (e.g., high-growth provider types, high-utilizing members) (20%)

  2. Assemble and manage cross-functional teams focused on addressing key challenges or opportunities. Identify project scope, develop work plans, and lead day-to-day efforts of staff in developing policy and/or operational recommendations. (20%)

  3. Engage stakeholders (e.g., members, advocates, providers) on relevant program changes to collect feedback on proposed recommendations. (10%)

  4. Provide coaching and guidance to analytical and program staff. (20%)

  5. Prepare and present formal recommendations to MassHealth executive team. (20%)

  6. Respond to urgent legislative or regulatory priorities as identified. (10%)

Education, licensure and certifications will be verified in accordance with the Human Resources Division’s Hiring Guidelines

  • Education and license/certification information provided by the selected candidate(s) is subject to the Massachusetts Public Records Law and may be published on the Commonwealth’s website.

As part of the hiring process, the Office of Human Resources will be verifying any college-level degrees conferred to the selected candidate. Additionally, any licensure required for the position will be verified. Information provided as part of the hiring process is subject to the Massachusetts Public Record Law and may be published on the Commonwealth’s website.

For questions, please contact the CYF Office of Human Resources at 1-800-510-4122 and select option #2.

MINIMUM ENTRANCE REQUIREMENTS:

Applicants must have at least (A) four (4) years of full-time or, equivalent part-time, professional, professional internship, administrative, supervisory, or managerial experience in business administration, business management, public administration, public management, clinical administration or clinical management or (B) any equivalent combination of the required experience and substitutions below.

Substitutions:

I. A certificate in a relevant or related field may be substituted for one (1) year of the required experience.

II. An Associate’s degree in a related field may be substituted for one (1) year of the required experience.

III. A Bachelor’s degree in a related field may be substituted for two (2) years of the required experience.

IV. A Graduate degree in a related field may be substituted for three (3) years of the required experience.

V. A Doctorate degree in a related field may be substituted for the required experience.

An Equal Opportunity / Affirmative Action Employer. Females, minorities, veterans, and persons with disabilities are strongly encouraged to apply.

Job: *Management

Organization: *Exec Office Of Health and Human Services

Title: Program Integrity Analyst

Location: Massachusetts-Quincy - 100 Hancock Street

Requisition ID: 170003TC