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Fallon Health ACO Program Support Coordinator - Growing Healthcare Organization in Worcester, Massachusetts


About Fallon Health

Founded in 1977, Fallon Health is a leading health care services organization that supports the diverse and changing needs of those we serve. In addition to offering innovative health insurance solutions and a variety of Medicaid and Medicare products, we excel in creating unique health care programs and services that provide coordinated, integrated care for seniors and individuals with complex health needs. Fallon has consistently ranked among the nation’s top health plans, and is accredited by the National Committee for Quality Assurance for its HMO, Medicare Advantage and Medicaid products. For more information, visit fallonhealth.org.

Brief Summary of Purpose:

Provide administrative support to assist in the Clinical Integration Team’s efforts to care manage all Fallon Health products.

Duties include but are not limited to:

Supporting the Clinical Integration Team Staff in processing and receiving all new NaviCare members or member transfers into long term care

  • Assisting in the management and ongoing administrative support of the members including but not limited to letter generation, contact updates, and other details in the documentation systems

  • Managing incoming faxes and member specific data, routing to the appropriate staff member

  • Producing and maintaining and distributing reports utilized by the Program to manage and facilitate member care

  • Providing back up to Team members

  • May include traveling as required for meetings, staff training, and other required duties/tasks


New Member Processing and Referral Functions:

  • Receives incoming member completed health risk assessment tools including but not limited to ACO member Care Needs Screenings, keypunching details in the documentation system and assigning members for outreach based upon member responses to trigger questions

  • Receives incoming member referrals and utilizing the documentation system to assign member for Care Team outreach in the various available Clinical Integration Team Program

  • Receives incoming new ACO members and initiating documentation system workflows and assignment to Care Team members for outreach

Member Related Supportive Functions (administrative):

  • Processes all incoming/outgoing member mail (letters, careplans and other approved materials) generated by the ACO Care Team staff and partners with accuracy

  • Manages incoming faxes and member specific data, routing to the appropriate Care Team member

  • Manages the Case Management ACD and generates/facilitates timely referrals to Care Team staff based upon product and assignment logic

  • Updates TruCare Contacts when members transition between care team members ensuring accurate care team membership as directed by Clinical Leader

  • Scans multiple types of documents into the TruCare system utilizing established protocols

Member Related Supportive Functions (detailed and unique to role):

  • Manages the TruCare ‘CM Intake Queue’ following established processes and assigns members to Clinical Integration Team staff for outreach and action

  • Receives and processes ACO member address change requests utilizing a CM mailbox in Outlook and communicates such to interdepartmental teams via QNXT Call Tracking

  • Receives requests for ACO member handbooks and other approved materials and communicates such to interdepartmental teams via QNXT Call Tracking

  • Provides coverage for Transportation on a needed basis to cover incoming issues related to ACO member transportation needs with transportation vendor

Reporting Related Functions:

  • Generates reports from Fallon Health Reporting systems and prepares and distributes reports to NaviCare employed team members as neededIdentifies errors in Membership Report, corrects, and works with Leaders to ensure accurate member related data if errors are not created by self

  • Generates and distributes reports for various contracted partners including but not limited to: Long Term Care Facilities, Adult Day Health Care Providers, Adult Foster Care Providers, Physician Practice Sites, and others as required

Other Functions:

  • Adheres to Fallon Health requirements for time clock use and time entry

  • Engages in extensive contact with all levels of personnel in a professional and confidential manner

  • As requested, promptly and courteously receives visitors to department or assists Program Department Administrative Assistant with meetings, department functions, and other activities

  • Answers phone courteously and promptly and takes accurate phone messages and relays timely as required

  • Supports department colleagues, covering and assuming changes in assignment as assigned by Manager/designee

  • Strictly observes HIPAA regulations and the Fallon Health policies regarding confidentiality of member information

  • Supports and helps any member of the Clinical Integration Team Leadership team by taking meeting minutes, distributing, and any other supportive requests to meet Program needs

  • Performs other responsibilities as assigned by the Manager/designee



College degree preferred; Minimum of high school diploma required


2+ years job experience in a medical related field or with a healthcare payor company.  Experience in a healthcare payer company or in a long term care facility setting a plus

Demonstrated proficiency including but not limited to:

  • Use of software programs including but not limited to Excel, Word, and other computerized systems utilized for documenting activity and actions including but not limited to scanning and generating correspondence

  • Must be able to prepare and manipulate spreadsheets (with or without pivot tables)

  • Independent learning skills and familiarity with various learning methodologies

  • Exceptional customer service and collaboration skills

  • Knowledge of medical terminology and experience with documenting in medical records

  • Critical thinking skills for independent problem solving

  • Attention to detail and accuracy of work output

Other: Satisfactory Criminal Offender Record Information (CORI) results

Fallon Health provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.

Location US-MA-Worcester

Posted Date 3 weeks ago (7/12/2021 11:31 AM)

Job ID 6417

# Positions 1

Category Administrative/Clerical