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Current Openings:

Health Plans offers an excellent working environment and a competitive wage/benefit package. If you are interested in any of the following positions, please email or fax your cover letter and resume to:

Email: jobs@healthplansinc.com

Fax: 508-329-4814

Claims Examiner

Department: Claims

Location: Westborough, MA

Description: The Claims Examiner is responsible for the processing of medical claims in accordance with applicable plan benefits. This position will handle of a specific block of group plans and is integral in maintaining the client/customer relationship with those group plans.  The Claims Examiner will also assist claimants, providers and/or clients with problems or questions regarding their claim and/or policies.

The ideal candidate will have a High School Diploma or equivalent; prior experience in claims processing, knowledge of medical terminology and/or billing and coding preferred. Must be able to work independently and as part of a team, be detailed, organized and able to prioritize tasks, work within timeframes and meet deadlines, recognize and maintain confidentiality, and communicate in a professional manner.  Proficiency with Microsoft Word and Excel required. 

 

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Imaging Specialist

Department: Imaging Services

Location: Westborough, MA

Description: The Imaging Specialist is responsible for accurate scanning of documents. In our Imaging Services area, this individual will sort all incoming daily mail, distribute all non-claim mail, and open and sort all claim mail; scan all standard claim forms and claim supporting documents. 

In addition, the Imaging Specialist provides receptionist support on a regular basis and as needed basis.

The ideal candidate will have a High School Diploma or equivalent; prior customer service experience a plus. Must be able to work independently and as part of a team, be detailed, organized and able to prioritize tasks, work within timeframes and meet deadlines, recognize and maintain confidentiality, and communicate in a professional manner. Proficiency with Microsoft Word and Excel required. Valid driver’s license required.

 

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Director of Compliance and Privacy Officer

Department: Corporate Compliance

Location: Westborough, MA

Reporting to Health Plans’ Vice President of Corporate Compliance and Regulatory Affairs and Harvard Pilgrim’s Privacy Officer (related to the privacy program), the Director of Compliance and Privacy Officer is responsible for developing, implementing and directing a comprehensive compliance and privacy program for Health Plans, Inc. and its subsidiary companies in accordance with federal and state requirements and guidance, as well as organizational policies and procedures. The Director is responsible for promoting a culture of compliance and ensuring that Health Plans has appropriate administrative, technical, and physical safeguards to protect (and access) the privacy of protected health information and personal information and ensure members' rights are protected in compliance with federal and state laws.  Such responsibilities include policy and procedure development and enforcement, training and education, and investigation and response to compliance and privacy issues and complaints.  The Director of Compliance and Privacy Officer will serve as Health Plans Privacy Officer and serves as an organizational resource on the laws, regulations and internal policies pertaining to privacy, health information, compliance, protected health information, and personal information.

Description:

  • Oversee and monitor the implementation of the Privacy and Compliance Programs for Health Plans and its subsidiaries.
  • Provide direct oversight of subsidiaries’ Privacy Officers and their privacy programs and initiatives.
  • Develop, implement, maintain and oversee compliance and privacy-related policies and procedures of the organization and work closely with the Security Officer on information security-related policies and procedures.
  • Conduct investigations of compliance and privacy-related complaints and respond to compliance and privacy-related inquiries from workforce members, health plan members, the compliance hotline or other sources. This work includes responding timely to incidents and inquiries received, documenting the work and actions taken in a central database, and tracking investigations and inquiries. 
  • Based on outcomes of compliance and privacy-related investigations, oversee and coordinate reporting to individuals, state and federal authorities, as appropriate.
  • Conduct risk assessments and develop work plans to address identified risks, including conducting audit and monitoring activities.
  • Develop, implement, maintain and oversee training and education programs for compliance and privacy issues for the organization, including, for example, new employee orientation, annual online training and department-specific training.
  • Develop and implement (or oversee implementation of) corrective action plans in response to complaints and investigations.
  • Cooperate with U.S. Department of Health and Human Services (HHS) Office of Civil Rights (OCR) and other federal and state entities, in any privacy program audits, inquiries or investigations.
  • Stay current with relevant federal and state compliance and privacy related laws and regulations and modify the compliance and privacy program accordingly to remain compliant, as well as consistent with industry best practices.
  • Analyze client, vendor and other entities’ requests for disclosure of member PHI/PI and determine applicable Confidentiality and Non-Disclosure Agreements, Business Associate Agreements or Privacy & Security Agreements required and coordinate process for issuing the applicable Agreements and maintaining database of Agreements. Review requested changes to issued Agreements and escalate to Vice President of Corporate Compliance for any material changes. Oversee and monitor Agreements issued by subsidiaries and their Agreement databases and assist with requested changes to issued Agreements, escalating to Vice President of Corporate Compliance for any material changes.
  • Chair the Health Plans Compliance Oversight Committee and provide compliance and privacy related reports to Health Plans Senior Leadership and Board of Directors.
  • Serve as company liaison to parent and subsidiaries regarding compliance and privacy-related programs and initiatives.


Required Education and/or Experience:

  • Bachelor’s degree or equivalent work experience required
  • 5-7 years of healthcare compliance, privacy, or other compliance related function that includes 3 years of experience managing an effective and comprehensive organization-wide privacy program that includes the protection and security of protected health information, auditing, investigations, communication and training.
  • Master’s Degree in health care field or Juris Doctor preferred
  • Knowledge and experience in information privacy laws, access, release of information, and corporate compliance.
  • Outstanding oral and written communication skills
  • Strong organizational and computer skills
  • Demonstrated ability to handle multiple priorities in a dynamic, fast-paced environment

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Flex Specialist

Department: Flex

Location: Westborough, MA

Description: The Flex Specialist is responsible for co-ordination and processing of daily activity relating to the administration of Flexible Spending and Health Reimbursement Accounts. The Specialist also interacts directly with customers to provide accurate and complete information.  The Specialist may closely with Account Managers during implementation of new groups and renewal of existing business. 

The ideal candidate will have a High School Diploma or equivalent.  Must have at least 2 years’ experience in a customer service/call center environment, preferably in the healthcare industry.  Must be able to work independently and as part of a team, be detailed, organized and able to prioritize tasks, work within timeframes and meet deadlines, recognize and maintain confidentiality, and communicate in a professional manner.  Proficiency with Microsoft Word and Excel required. 

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Provider Pricing Specialist

Department: Technical Resource Unit (TRU)

Location: Westborough, MA

Description: The Provider Pricing Specialist is responsible for managing provider database information, provider association with claims, and the set-up of online customer portals.  Will assist with research to settle claim pricing questions, as well as the provider and member appeal process.  Will provide assistance in all department research activities.

The ideal candidate will have a High School Diploma or equivalent; prior experience with medical terminology and/or billing and coding preferred.  Must be able to work independently and as part of a team, be detailed, organized and able to prioritize tasks, work within timeframes and meet deadlines, recognize and maintain confidentiality, and communicate in a professional manner.  Proficiency with Microsoft Word and Excel required.

 

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Compliance & Privacy Specialist

Department: Compliance

Location: Westborough, MA

Under the direction of the Director of Compliance and Privacy Officer, the Compliance and Privacy Specialist will assist with managing, developing, implementing and monitoring a comprehensive Compliance and Privacy Program in accordance with Health Plans’ policies and federal and state requirements and guidance. The Specialist will work collectively with the Director, senior leadership, and subsidiaries management to ensure that compliance and privacy initiatives are implemented appropriately. As directed, the Analyst will assist with leading efforts implementing, monitoring, and tracking Compliance and Privacy Program elements and providing direction and guidance to subsidiaries personnel for adherence to industry regulations, organization policies, Federal Sentencing Guidelines, HIPAA, and applicable federal and state requirements.

The ideal candidate will have a Bachelor’s Degree and the equivalent of 2 – 4 years’ of full-time experience with compliance, privacy, confidentiality, health information management, or information security in the healthcare industry. Advanced degree (e.g. JD, MHA, MPA, etc.) preferred. Will also possess the following:

  • Strong commitment to maintain confidentiality and privacy.
  • Knowledge of and experience in working with federal and state privacy laws, including those pertaining to access, release of information, and release control technologies.
  • Commitment and ability to:
    • Work in a team-based environment;
    • Handle member interactions/communication with extreme care, patience and consideration; and
    • Create an environment with open channels of communication within the organization with workforce members, members and others.
  • Possess excellent organization, attention to detail, facilitation, technical and analytical skills. Can gather relevant information systematically, break down problems into simple components and can make sound decisions.
  • Approach problems with curiosity and open-mindedness and offer new ideas, solutions and/or options. Demonstrate discretion, diplomacy, and good judgment.
  • Possess strong communication and presentation skills; clearly and concisely express ideas in groups and one-to-one conversations, formal and informal documents. Adapt writing and communications styles to fit the audience.
  • Project management and change management skills; ensuring projects come to fruition from inception to completion.
  • MS Office (Word, Excel, Access, PowerPoint) expertise and knowledge of or ability to learn electronic medical record auditing software.

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