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Fallon Health Administrative/Back Office Program Support Coordinator for Dynamic Care Management Teams in Worcester, Massachusetts

Overview

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.

About NaviCare :

Fallon Health is a leader in providing senior care solutions such as NaviCare, a Medicare Advantage Special Needs Plan and Senior Care Options program. Navicare integrates care for adults age 65 and older who are dually eligible for both Medicare and MassHealth Standard. Apersonalized primary care team manages and coordinates the NaviCare member’s health care by working with each member, the member’s family and health care providers to ensure the best possible outcomes.

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!

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.

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?

If yes, apply now and learn more about this role and our dynamic team!

Brief Summary of Purpose:

The Senior and Commercial Product Program Support Coordinator’s function and role assists the Clinical Integration staff in providing care management services to Fallon Health member populations. The Program Support Coordinator performs valuable ‘back office’ functions that support and enable the various roles in the department to outreach and work with member populations.

Duties include but are not limited to:

  • 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 Programs

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

  • Reconciles new and established NaviCare members and established members and informing the Care Team staff when members no longer are eligible for coverage

  • 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 generated by the Care Team staff with accuracy

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

  • Produces, manipulates, and maintains various reports utilized by the Clinical Integration Team to manage and facilitate member care

  • Produces, manipulates, generates and sends monthly ASAP rosters with NaviCare membership ensuring accuracy in data regarding member status

  • Supports the Clinical Integration Team with data reconciliation efforts including but not limited to entering data into the QXNT and TruCare systems to ensure accuracy in reporting

  • Manages incoming requests from vendors/ASAPs/providers for access to the TruCare Documentation system performing reconciliations with vendors/ASAPs/providers

  • Manages deactivation for vendor/ASAP/provider TruCare users when access no longer required in conjunction with I.T. department

  • Generates and updates rosters of vendor/ASAP/provider TruCare users

  • Receives and processes incoming vendor invoices ensuring members receiving services at such point in time have active membership

  • Provides back up to Team members and is fully trained in all functions completed by Department Team

  • Demonstrates a detailed working knowledge of the TruCare documentation system as well as Fallon Health’s core system QNXT

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 new NaviCare members and initiating documentation system workflows and assignment to Care Team members for outreach

  • Reconciles new and established NaviCare members and established members and informing the Care Team staff when members no longer are eligible for coverage

  • Receives new NaviCare member enrollment notification (enrollment/disenrollment) from the Operations Team and initiates new member workflow processes in the TruCare documentation system

  • Maintains accurate Team member assignment logic system(s) keeping abreast of staff arrival/departure/team changes to ensure assignment logic is current escalating needs for change to assignment logic ongoing

  • Creates NaviCare new member detail report for current and future month creating pivot tables demonstrating volume of new NaviCare members to nurse case manager and navigator staff each business day and reconciles to ensure accuracy and timeliness of new member processing

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

  • 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 various queues in the TruCare system following established processes, 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

  • Receives requests for member changes and communicates such to interdepartmental teams via QNXT Call Tracking

  • Utilizes Smart Data for processing invoices for interpreter services as well as processing NaviCare Advanced Practitioner member visit notes to ensure proper CMS coding

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

  • Receives and processes incoming vendor invoices ensuring members receiving services at such point in time have active membership

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

  • Manages incoming requests from vendors/ASAPs/providers for access to the TruCare Documentation system performing reconciliations with vendors/ASAPs/providers

  • Manages deactivation for vendor/ASAP/provider TruCare users when access no longer required in conjunction with I.T. department

  • Generates and updates rosters of vendor/ASAP/provider TruCare users

  • 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

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 folder and distributes the report by email to all staff working on the NaviCare product

  • Receives monthly Long Term Care 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

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 department emergency phone courteously and promptly and takes accurate phone messages and relays timely

  • 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

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 weeks ago (3/30/2021 1:34 PM)

Job ID 6294

# Positions 1

Category Administrative/Clerical

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