Fallon Health Provider Data Manager in Worcester, Massachusetts
About Fallon Health:
Fallon Health is a company that cares. We prioritize our members—always—making sure they get the care they need and deserve. Founded in 1977 in Worcester, Massachusetts, Fallon delivers equitable, high-quality coordinated care and is continually rated among the nation’s top health plans for member experience, service, and clinical quality. Today, guided by our mission of improving health and inspiring hope, we strive to be the leading provider of government-sponsored health insurance programs—including Medicare, Medicaid, and PACE (Program of All-Inclusive Care for the Elderly)— in the region. Learn more at fallonhealth.org or follow us on Facebook, Twitter, and LinkedIn.
Brief Summary of Purpose :
Manage Provider Data Management team. Develop and build successful procedures to conduct provider outreach, data validation and updates into Core Record keeping system. Respond to regulatory requirements impacting provider data including but not limited to data points required by the healthcare industry, State and Federal reports, audits and provider directory requirements. Manage corporate key performance indicators. Implement and/or modify core record keeping system to deliver and maintain accurate provider data.
Responsible for hiring, developing, and retaining the highest quality Provider Data Specialists as needed.
Regularly analyze and report on the productivity and quality to ensure effectiveness of the operations in comparison to established performance metrics. Identify areas of improvement and recommend resolution.
Work cross-functionally to ensure operations and changes are well integrated.
Proactively seek feedback from other groups on the impact and effectiveness of current and changes to operations.
Implement, manage, and refine business processes required to deliver expected business results.
Keep abreast of relevant regulatory (pending and potential) updates. Identify and plan for potential impact to operations.
Ensure relevant changes to operations and/or contractual requirements can be supported.
Ensure operational compliance with all relevant regulatory agencies.
Ensure operations meet vendor/customer contractual requirements.
Proactively identify areas of concern or exceptions and promptly notify stakeholders
Serve as a subject matter expert and provide peer support in a mentoring or collaborative capacity in the office environment, whether it be training or answering of questions, as deemed appropriate by management.
Provides work direction, mentoring, and training to all staff as needed.
Oversees daily activities of team.
Conducts performance reviews and evaluations for the Provider Data Specialists.
Reviews and approves requests for time off. Manages calendar to meet the needs of Provider Data Management team.
Monitor work of individual staff for productivity, attendance, efficiency, effectiveness, and quality. Provide ongoing constructive feedback and guidance to team.
Identifies and implements appropriate process improvements to improve the quality of provider data and streamline workflows.
Attends internal and external meetings as required and represents the Provider Data Management team as applicable.
Works to foster a positive and team-oriented spirit within the Provider Data Management team and collaboratively within Configuration and Support within Fallon Health
Develops and maintains tracking and monitoring systems to ensure compliance and consistency or established standards and procedures
Responsible for reporting of all applicable Provider Data Management activities (inventory, competed, SLAs etc.
Responsible for operational metric reporting
Other duties as assigned.
Bachelor's degree or advanced education preferred
2+ years’ experience at a health plan in Provider Data. Minimum 2 years of supervisory experience highly preferred.
Proficiency with call center workflow
Ability to identify efficient workflow for data administration
Experience with relational databases.
Knowledge of Microsoft programs and other reporting means to track, update and analyze data.
Ability to coach, mentor, and maintain a positive work environment.
Strong Communication and Presentation skills.
Strong Analytical Ability
Extensive knowledge of federal and state regulations, legislation and laws, auditing reports and system functions; comparing functions with established standards.
Ability to and experience in forecasting.
Ability to perform root causal analysis and impact assessments with the goal of mitigation and/or process improvements
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.
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.
Posted Date 4 weeks ago (11/10/2022 12:33 PM)
Job ID 7051
# Positions 1
Category Provider Relations