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Fallon Health Administrative Coordinator - Hybrid Role with Career Growth in Worcester, Massachusetts

Overview

Fallon Health Vaccination Requirements:

To protect the health and safety of our workforce, members and communities we serve, Fallon Health now requires all employees to disclose COVID-19 vaccination status. As of 2/1/2022, all roles not designated as “Remote” require full COVID-19 vaccination and Fallon Health will obtain the necessary information from candidates prior to employment to ensure compliance. Failure to meet the vaccination requirement may result in rescission of an employment offer or termination of employment.

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.

Overview:

Do you like to help patients/members but don’t want to be on the front lines? Do you have the organization, communication, administrative and collaboration skills to help our Care Management Teams assist Fallon Health members to access and coordinate their care? If yes, this hybrid (in office and at home) role is for you! Do you have strong working knowledge of Microsoft products including excel pivot tables and enjoy working with data and reports? Are you organized and want to help patients without being on the front lines?

This role is pivotal in performing valuable ‘behind the scenes’ functions that support our Care Management Teams. Duties include but are not limited to: receiving and assigning new members to our Care Teams, facilitating mailings to members, receiving incoming medical records and ensuring information is provided to the correct Care Teams, working in partnership with community agencies such as the Aging Service Access Points (Elder Service Agencies) ensuring access to our systems and communication and managing data and reports.

This position performs valuable ‘back office’ functions that support and enable the various roles in the department to outreach and work with member populations.

Responsibilities

New Member Processing and Referral Functions:

  • Receives incoming member completed health risk assessment tools including but not limited to Medicare 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 member completed health risk assessment tools including but not limited to Medicare 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

Member Related Supportive Functions (administrative):

  • Creates NaviCare member authorizations in the QNXT system for member admissions to long term care facilities for short term and custodial care

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

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

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

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

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

  • Manages various queues in the TruCare system following established processes for a variety of workflows. , including but not limited to the SCO LTC Queue for all NaviCare Short Term Custodial and Long Term Care admission/discharge/extension related communication

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

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

TruCare System Access Related Functions – Vendor Management Functions:

  • Reconciles monthly NaviCare ASAP rosters in preparation for automated sending and corrects and resends ASAP rosters when discrepancies are identified maintaining master rosters on the group drive

Reporting Related Functions:

  • Obtains the Daily NaviCare Discharge Report from the Collective Medical Portal, formats the report to a user-friendly view, saves it in the appropriate G-drive folderand distributes the report by email to all staff working on the NaviCare product

  • Receives, manipulates and distributes monthly Long Term Care Reports to appropriate team members per current workflows. to support our NaviCare LTC Rating Category discrepancy file and manipulates and sends to the appropriate Long Term Care Navigator to work with the facilities maintaining up to date information on new, closed, and pending discrepancies

  • Runs the NaviCare Long Term Care membership report from Business Objects and manipulates per process and sends to Senior Accounting Analyst, designated long term care facilities, and NaviCare Sales Team

Qualifications

Education:

College degree preferred; Minimum of high school diploma required

Experience:

2+ years job experience in an administrative supportive role required.Experience with medical terminology required. Experience in a healthcare company required.

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 – ability to type/utilize keyboard with speed and accuracy

  • Ability to prepare and manipulate spreadsheets (with or without pivot tables)

  • Effective collaboration, team work, communication, and change management skills

  • Attention to detail and accuracy of work output

  • Ability to provide input to step by step process document creation and updating

  • Ability to recognize and recommend process changes to enhance efficiency of output and team production

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.

PM16

Location US-MA-Worcester

Posted Date 2 months ago (3/24/2022 4:25 PM)

Job ID 6780

# Positions 1

Category Administrative/Clerical

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