What are the responsibilities and job description for the Program Administrator, HRSN position at South Middlesex Opportu?
Summary: The HRSN Program Administrator will spearhead the development and implementation of operational processes necessary for the effective delivery of Health-Related Social Needs (HRSN) services. This role is pivotal in establishing and refining processes affected by the HRSN framework, that was launched on January 1, 2025. The Administrator will ensure seamless coordination with insurance entities, billing, and accounts payable departments for successful claim submission. The Program Administrator is responsible for the collection, analysis and reporting of service utilization data. The Administrator implements billing workflows for HRSN and CSPHI programs.
Why Work for SMOC?
- Paid Time Off: All full-time employees can accrue up to 3 weeks of vacation, and 2 weeks of sick time and are eligible for 12 paid holidays during their first year of employment.
- Employer-paid Life Insurance & AD&D and Long-Term Disability for full-time employees.
- Comprehensive Benefits Package including Medical Plans through Mass General Brigham with an HRA Employer cost-sharing program, Dental Plans with Orthodontic Coverage, and EyeMed Vision Insurance available to full-time employees.
- 403(B) Retirement Plan with a company match starting on day one for all full-time and part-time employees.
- Additional voluntary benefits including; Term and Whole Life Insurance, Accident Insurance, Critical Illness, Hospital indemnity, and Short-Term Disability.
- Flexible Spending Accounts, Dependent Care Accounts, Employee Assistance Program, Tuition Reimbursement and more.
Key Responsibilities:
- Develop and implement business and operational practices to support HRSN service delivery.
- Establish and maintain interagency linkages to support increased service enrollment
- Coordinate accurate and timely billing and claims processes in alignment with the HRSN framework.
- Interface with insurance companies for service approvals, billing, and accounts payable functions.
- Establish effective workflows for verifying and maintaining client eligibility for services and avoiding failed claims
- Continuously monitor documentation in multiple client electronic health record systems for compliance with billing requirements including timeliness and frequency
- Liaise with accounts payable and ensure time-sensitive payments are made correctly to aid in client needs
- Train staff, both new and existing, on transitions to the new HRSN billing and operational processes.
- Identify operational barriers and implement solutions to address delays in client assistance payments
- Assure tracking of insurance reviews, and that reviews are completed in a timely manner.
- Regularly update Utilization reports and other statistical data required by third party payers or funders and prepare documentation of significant findings.
- Procure and deliver program and client supplies in a timely manner and within set budget
- Provide administrative oversight and support case managers to ensure efficient operations and high-quality service delivery
- Provide administrative support needed to maintain compliance with regulators of the HRSN and related program as directed by the Director of Community Support Services.
- Collect, organize and communicate service utilization data for ease of access for review and analysis.
- Analyze data to identify trends, inefficiencies, and areas for improvement in service utilization.
- Prepare reports and visualizations to effectively communicate findings to management and other stakeholders.
Qualifications:
- Proven experience in program administration, preferably in healthcare or a related field.
- Experience data management, analysis and reporting
- Understanding of healthcare billing and claims processes.
- Familiarity with insurance coordination and accounts payable operations.
- Excellent organizational and problem-solving skills.
- Ability to train and guide staff transitioning to new operational frameworks.
- Strong interpersonal skills to work collaboratively with internal teams and external partners.
- Adaptability to operational changes and a focus on maintaining positive client experiences.
Knowledge and Skill Requirements:
- Bachelor’s degree in Business Administration, Healthcare Administration, Social Work or a related field.
- Proven experience in program administration, preferably within social services or healthcare.
- Experience in data management, organization and analysis using excel
- Exceptional organizational skills and attention to detail.
- Knowledge of billing processes and claims management.
- Excellent communication and interpersonal skills.
- Ability to adapt to new operational frameworks and procedures.
- Proficiency in using relevant software applications including office suite
Opportunities:
- Play a crucial role in expanding SMOC’s capacity to administer HRSN services.
- Enhance operational effectiveness within the HRSN framework.
- Contribute to maintaining and improving client housing stability through effective service delivery.
Physical Requirements: Ability to walk up flights of stairs and drive to multiple location within the state of MA
Organizational Relationship: Directly reports to the Director of Community Support Services
9am-5pm ; Monday-Friday
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