MassHealth, the Commonwealth's Medicaid program, plays a critical role in ensuring access to high-quality, equitable health care for millions of Massachusetts residents. We are seeking candidates for the Program Integrity Coordinator. The selected candidate serves as an essential member of the Audit Response and Fraud Enforcement Unit, supporting efforts to safeguard public resources and uphold program accountability. This position sits at the intersection of data, compliance, and cross-agency collaboration. It involves coordinating complex workflows related to fraud investigations and external audits, while ensuring that information is accurate, timely, and actionable. The role provides strong exposure to high-impact initiatives, including coordination with law enforcement partners, oversight of audit activity, and participation in initiatives that influence policy, compliance, and operational improvements. We are seeking candidates who enjoy analytical work, organization, and problem-solving in a mission-focused environment. The Program Integrity Coordinator offers the opportunity to build expertise in healthcare program integrity, audit processes, and fraud detection while working alongside experienced professionals across state agencies and external partners. Individuals in this role will gain valuable experience in project management, data analysis, and strategic coordination, all while contributing to efforts that protect critical healthcare resources and ensure services reach those who need them most. /Duties and Responsibilities (these duties are a general summary and not all inclusive):/ · Coordinate and track law enforcement requests related to provider and member fraud investigations, ensuring accurate documentation and timely follow-up. · Maintain and manage tracking systems, databases, and reporting tools to monitor case activity, referrals, payment suspensions, and recovery efforts. · Analyze and interpret MassHealth data to support fraud identification, trend analysis, and data-informed decision-making. · Develop and enhance tracking tools and analytical resources to support fraud response and program integrity initiatives. · Monitor case outcomes and recovery trends, providing insights to inform operational and strategic decisions. · Prepare analytical memoranda, reports, and presentations to support fraud enforcement and audit response activities. · Coordinate responses to external audit requests, ensuring consistency, completeness, and adherence to established timelines. · Manage intake, triage, and tracking of audit-related inquiries, including routing, response coordination, and follow-up actions. · Facilitate communication and collaboration with internal teams and external partners to support audit processes and investigative activities. · Support project management efforts by organizing meetings, documenting key discussions, and tracking action items related to audit and fraud initiatives. /Required Qualifications:/ - Knowledge of the methods of general report writing. - Ability to analyze and determine the applicability of data, to draw conclusion and make appropriate recommendations. - Ability to assemble items of information in accordance with established procedures. - Ability to maintain accurate records and prepare general reports. - Ability to follow written and oral instructions, and to give written and oral instructions in a precise, understandable manner. - Ability to establish rapport and deal tactfully with others. - Ability to adjust to varying or changing situations to meet emergencies or changing program requirements. - Ability to exercise sound judgment. - Ability to exercise discretion in handling confidential information. /Preferred Qualifications:/ · Experience working with Medicaid, Medicare, or other public health insurance programs. · Familiarity with healthcare program integrity, fraud detection, or audit processes. · Demonstrated experience analyzing large datasets and translating findings into actionable insights. · Strong project management skills with the ability to manage multiple priorities in a fast-paced environment. · Skilled in developing and maintaining tracking systems, dashboards, or reporting tools. · Ability to communicate complex information clearly through written reports and presentations. · Capacity to collaborate with cross-functional teams, including legal, compliance, or external partners. · Knowledge of state or federal regulations related to healthcare programs or public sector operations. · Strong attention to detail with a demonstrated ability to ensure accuracy, organization, and follow-through. · Proficient in data tools and systems such as Cognos, MMIS, or similar reporting platforms as well as Microsoft Office applications including Excel, Word, Outlook, PowerPoint, and Teams. /About MassHealth:/ The mission of MassHealth is to improve the health outcomes of our diverse members, their families, and their communities by providing access to integrated health care services that sustainably promote health, well-being, independence, and quality of life. For more information about our agency and programs please visit: www.mass.gov/masshealth /Pre-Hire Process:/ A criminal background check will be completed on the recommended candidate as required by the regulations set forth by the Executive Office of Health and Human Services prior to the candidate being hired. For more information, please visithttp://www.mass.gov/hhs/cori. 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. ADA Reasonable Accommodation: If you require a reasonable accommodation with the application/interview process, please contact us at: EOHHS Candidate ADA Requests For questions about this requisition, please contact Employment and Staffing Customer Service at 1-800-510-4122, option 4. Questions or issues regarding access/login credentials to MassCareers, please contact the Mass HR ESC at 617-979-8500. First consideration will be given to those applicants that apply within the first 14 days. MINIMUM ENTRANCE REQUIREMENTS: Applicants must have at least (A) three years of full time, or equivalent part-time, professional, administrative or managerial experience in business administration, business management or public administration the major duties of which involved program management, program administration, program coordination, program planning and/or program analysis, or (B) any equivalent combination of the required experience and the substitutions below. Substitutions: I. A Bachelor's degree with a major in business administration, business management or public administration may be substituted for a maximum of two years of the-required experience. II. A Graduate degree with a major in business administration, business management or public administration may be substituted for the required experience. III. A Bachelor's or higher degree with a major other than in business administration, business management or public administration may be substituted for a maximum of one year of the required experience. Education toward such a degree will be prorated on the basis of the proportion of the requirements actually completed. Salary placement is determined by a combination of factors, including the candidate's years of directly related experience and education, and alignment with our internal compensation structure as set forth by the Human Resources Division's Hiring Guidelines. For all bargaining unit positions (non-management), compensation is subject to the salary provisions outlined in the applicable collective bargaining agreement and will apply to placement within the appropriate salary range. Comprehensive Benefits When you embark on a career with the Commonwealth, you are offered an outstanding suite of employee benefits that add to the overall value of your compensation package. We take pride in providing a work experience that supports you, your loved ones, and your future. Want the specifics? Explore our Employee Benefits and Rewards! An Equal Opportunity / Affirmative Action Employer. Females, minorities, veterans, and persons with disabilities are strongly encouraged to apply. The Commonwealth is an Equal Opportunity Employer and does not discriminate on the basis of race, religion, color, sex, gender identity or expression, sexual orientation, age, disability, national origin, veteran status, or any other basis covered by appropriate law. Research suggests that qualified women, Black, Indigenous, and Persons of Color (BIPOC) may self-select out of opportunities if they don't meet 100% of the job requirements. We encourage individuals who believe they have the skills necessary to thrive to apply for this role. Job: Administrative ServicesOrganization: Exec Office Of Health and Human Services Title: Program Integrity Coordinator Location: Massachusetts-Boston-1 Ashburton Place Requisition ID: 260002OZ
