AgeSpan

About Us: Since 1974 our agency has strived towards supporting an individual's desire to make their own decisions, secure their independence and remain living independently in the community. We are proud of our employees who make this possible every day. Our agency is a thought-leader, a nationally known generator of new ideas, because it welcomes creativity, your ideas. It is an outstanding place to work stimulating, friendly, collaborative. We offer competitive salaries, generous vacation time, and an excellent work/life balance. We value diversity and encourage career growth. If you have a passion for improving the lives of the elderly community and enjoy working in a diverse team driven by its mission, you've found the right place!

At AgeSpan, you'll find a work environment that combines:

A refreshing culture that is supportive, collaborative, and encouraging of diverse perspectives and backgrounds.
A focus on innovation with a team recognized for developing and implementing innovative programs and novel solutions.
Encouragement of your development through opportunities to get involved, use your voice, and gain new knowledge and skills.
A satisfying balance between your work and personal life, including a flexible workplace, generous paid time off, and wellness programs.

Depending on your role and your hours, we offer

Flexible schedule and hybrid work opportunities
Competitive salaries
Healthcare (medical, dental, vision)
403b Retirement Plan with agency match
20 Vacation Days, 12 Sick Days, and 12 Paid Holidays
Social Work Licensing Program
License Renewal Paid by agency for RN's and Social Workers
And MORE!

Position Summary: The Massachusetts Senior Medicare Patrol (SMP) Program is part of a national initiative to reach, educate, and counsel Medicare and Medicaid beneficiaries, family members, and caregivers across the Commonwealth to protect, detect, and report healthcare errors, fraud, and abuse. The Complex Interaction Specialist will be responsible for all intakes of fraud allegations from complainants across the state, Medicare beneficiaries, family members, healthcare entities, and others. They will be responsible for all aspects of managing Complex Interactions and work with MA SMP Volunteer Complex Interaction Counselors to ensure timely resolution for all complaints.

Program Responsibilities:

Responsible for all aspects of the program's complex "case management" under the guidance and supervision of the MA SMP Program Director, including processing all MA SMP case intakes, brought forth by complainants with allegations of healthcare errors, fraud, and abuse.
Secure signed Release of Information (ROI) forms and all other pertinent documentation in support of each complaint/allegation brought to the attention of the MA SMP Program to ensure expeditious case resolution. Ensure prompt uploading of all supporting documents to the respective case file/s in the SIRS database and agency files.
Collect all required supporting documentation related to complaints resolved, demonstrating resolution and proof of cost avoidance, financial recovery and/or other savings per the Office of the Inspector General's (OIG) requirement.
Review all resolved cases "ready to be closed" with respective Complex Interaction Counselor/s to ensure that the explanation re: monetary savings, such as cost avoidance and/or expected recoveries to Medicare and/or Medicaid or actual savings to the beneficiary is precisely documented with supporting documentation accurately uploaded to SIRS.
Close Complex Interaction Cases in consultation with the MA SMP Program Director for Quality Assurance.
In consultation with the MA SMP Program Director, assign cases to the appropriate MA SMP Volunteer Complex Interaction Counselor/s, and oversee the status and progression of assigned cases to inform and update the MA SMP Program Director weekly.
Consult with the MA SMP Program Director weekly, or as needed, regarding cases that need to be referred to ACL for the OIG, Office of the Attorney General, Centers for Medicare and Medicaid Services, Quality Improvement Organization, or other investigative and/or law enforcement entities, advocacy organizations such as Legal Services, Health Law Advocates, etc.
Plan and convene regular bi-weekly meetings with SMP Volunteer Complex Interaction Counselor/s and the MA SMP Program Director to discuss and strategize possible solutions related to the healthcare errors, fraud, and abuse allegations brought to the attention of the MA SMP Program.
Maintain up-to-date documentation in SIRS database and in client case files to ensure accurate statistical records, and compliance with reporting requirements from the Administration for Community Living (ACL), Office of the Inspector General (OIG) and AgeSpan.
Other activities as assigned.
Participate in regular SMP team meetings, supervision meetings, departmental, and general staff meetings as scheduled.

Qualifications:

BA/BS and minimum of three years of work experience preferred.
Participate in the SMP Foundations Training within the first thirty days of employment.
Ability and willingness to become SHINE trained and certified within the first year of employment.
Experience working with diverse, multicultural and LEP populations.
Experience in delivering presentations and public speaking.
Excellent communication skills, both written and spoken.
Computer proficiency, such as Office 365, Excel, PowerPoint, and ability to adapt to new software programs and databases.
Proficiency with Survey Monkey, and social media platforms such as (Facebook, Twitter, Instagram, etc.).
Excellent organizational skills, attention to detail, and self-motivated.
Ability to prioritize multiple tasks and complete assignments in a timely manner with minimal supervision.
Ability to travel in-state and out of state when necessary.
Ability to lift and carry SMP materials, up to 30 pounds.
Valid driver's license and reliable transportation required.
Flexibility and willingness to work some evenings and/or weekends, if necessary.
Bilingual and bicultural applicants are strongly encouraged to apply.

This is a grant funded position. Continuation is contingent on funding.

Hours: 37.5 hours per week

Our Commitment to Diversity and Inclusion

AgeSpan is strongly committed to fostering a professional environment that recognizes, respects, and encourages the unique contributions of a broad spectrum of qualified employees. It is important that our employees reflect the diverse communities we serve. We maintain a work atmosphere that allows people of varied backgrounds to grow professionally and contribute to our mission by promoting diversity, equity, inclusion, and work-life balance.

Job Posted by ApplicantPro