• Serve as the Key Contact and primary interface for designated integrated care plans. • Develop productive relationships with integrated care plan key contacts, and provide technical support and assistance as needed to plans. • Review plan marketing material submissions, annual benefits material submissions, audit materials, and other required materials as needed.• Handle member and other external inquiries and concerns effectively and with compassion. • Monitor the performance of integrated care plans to ensure compliance with contractual requirements including, but not limited to, all contractual reporting requirements, grievance and appeals processes, and the resolution of individual appeals, complaints, and denied claims.• Use quality, financial and other performance data to monitor and manage assigned integrated care plans toward improved performance and member outcomes.• Lead or participate in special projects and work groups to promote operational efficiencies that will lead to better experience for members and providers engaged in integrated care programs.• Work closely with the OLTSS leadership team and quality staff to oversee quality management and program evaluation for assigned integrated care plans. • Coordinate the research of answers and issue resolution related to covered benefits, member access to care, and other program related items. • Participate collaboratively in state/federal partnerships, including contract management and program management activities• Conduct or participate in training and outreach sessions for integrated care as needed.• Maintain open lines of communication with internal, external, and interagency stakeholders to ensure ongoing collaboration, coordination and input.

• Supervision of Program Coordinators to ensure resolution of all transportation claims denials, incidents, and complaints are resolved in a timely manner. • Responsible for collecting, analyzing, and reporting data on costs and operations, preparing annual cost and trip projections based on prior years data, identifying operational process improvement opportunities and implementation strategies. • Provide management guidance in the development and implementation of new transportation policies and procedures relating to the delivery of transportation to MassHealth members and other state agencies as needed. • Provide policy guidance on MassHealth non-emergency Transportation Brokerage contracts with contracted regional transit authorities (RTAs); recommend process improvement opportunities and implementation strategies and respond to daily inquiries regarding RTA services. • Handle escalated member and RTA issues regarding member eligibility, scheduling, complaints, and claims. • Work in collaboration with the HST Brokerage Operations Manager and the Transportation Manager on operation, policy, program and management issues; and preparation of position papers on HST priorities, strategies, and policies.

• Recipient of the MAXIMUS, Inc. CEO Excellence Award in July 2013; a corporate award for employees who demonstrate excellence in delivering quality, profitability and growth, and demonstrate exceptional leadership, strategic planning, outstanding customer focus, strategic workforce utilization and/or significant process management improvements. • Manage Call Center staff within the Transportation unit. Including, shift schedule, interviewing and hiring, salary reviews, performance, quarterly bonus evaluations, disciplinary action and training.• Manage preparation of appeal materials, including representing MassHealth in telephonic Transportation Appeal hearings.• Research, and efficiently resolve escalated member and provider Transportation issues• Responsible for daily workflow assignments/rotations, peer to peer training, employee vacation approvals, and shift rotations• Handle escalated member and provider issue and education calls members• Assist staff with updates and training of State Regulations, verification requirements, policies and procedures• Review Prescription for Transportation (PT-1) forms, requests for personal reimbursement for medical transportation, and ad hoc inquires• Responsible for monthly reports to the EOHHS regarding state contract performance expectations and SLAs.• Work closely with Human Services Transportation at EOHHS to report, monitor and track any regional transit authority trends and issues• Facilitate monthly meetings with MassHealth and Human Services Transportation to review state regulation and operational changes• Deliver Transportation department training to all newly hired staff• Subject matter expert on transportation-specific issues, including performing quarterly audit of all department related Call Center articles for CST staff

Analyze, research, and efficiently resolve member and provider Transportation Prior Authorization issues.Educate members, providers and Customer Service Representatives in State Regulations, verification requirements, policies and procedures.Review Prescription for Transportation (PT-1) forms, requests for personal reimbursement for medical transportation, and any supervisor inquiries.Monthly reporting for State contract performance expectations.Monthly one-on-one evaluations with staff, as well as quarterly bonus evaluations.Assist with Transportation training for newly hired staff.Meet with Human Services Transportation (Executive Office of Health and Human Services) on a regular basis to review regulation updates, and operational changes.Back-up to Appeals Coordinator, preparation for, and conducting Transportation Appeals hearings.

Responsible for shift schedule to include: daily workflow assignments/rotations, employee training, employee vacations, employee breaks, back up for absent employees, and shift rotations. Analyze, research, and efficiently resolve member and provider Transportation Prior Authorization issues.Educate members, providers and Customer Service Representatives in State Regulations, verification requirements, policies and procedures.Review Prescription for Transportation (PT-1) forms, requests for personal reimbursement for medical transportation, and any supervisor inquiries. Monthly reporting for State contract performance expectations. Monthly one-on-one evaluations with staff, as well as quarterly bonus evaluations. Assist with Transportation training for newly hired staff. Meet with Human Services Transportation (Executive Office of Health and Human Services) on a regular basis to review regulation updates, and operational changes. Back-up to Appeals Coordinator, preparation for, and conducting Transportation Appeals hearings.

Receive, and respond to incoming member and provider telephone calls.Analyze, research and efficiently resolve member and provider issues.Educate members in MassHealth eligibility standards, State regulations, verification requirements, policies and procedures.Review claim inquiries, monthly premiums, and Managed Care enrollment.Educate, and escalate pharmacy, billing, and transportation authorization requests accordingly.

Receive, and respond to incoming member and provider telephone calls.Analyze, research and efficiently resolve member and provider issues.Educate members in MassHealth eligibility standards, State regulations, verification requirements, policies and procedures.Review claim inquiries, monthly premiums, and Managed Care enrollment. Educate, and escalate pharmacy, billing, and transportation authorization requests accordingly.

Institutional Trading - Incoming WiresReceive, monitor, and process routine income wire transactions requested by clients and/or brokers, and dealers.Performing first, and second line Quality Assurance on all department processed transactions.Research, and resolve routine-processing problems as needed; communicate daily with management regarding daily work processed.Author all department training procedures, and administer it within peer-to-peer training.

Process routine transactions.Operate an imaging workstation and enter new accounts, cash transactions, maintenances and other type of transactions.Assist Customer Service department in resolving customer inquiries.Quality assurance for all department transactions, and reconciliation.Research and resolve routine problems as needed.Complete necessary forms, prepare daily/monthly reports and maintain work logs.