Fallon Health Provider Data Specialist 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.
Brief Summary of Purpose:
The Provider Data Specialist conducts outbound calls to providers to validate provider data in Fallon Health’s core record keeping system. Post validation, Provider Data Specialist will document calls taken identifying data changes obtained from provider. Provider Data Specialist will make required changes post documentation to provider records as required within service level agreements.
Key Accountabilities :
Contact providers for updates to provider data
Validate provider data
Update provider data- determine completeness of forms prior to entry. Research any misleading or missing data fields and escalate any unresolved issues to Manager.
Initiating and receive provider calls as necessary in order to validate and collect required provider data
Receive direction from providers/provider office staff via phone, email or other acceptable means
Update provider records in core record keeping system
Verifies entered data by reviewing, correcting or re-entering data
Document all provider data changes
Proven ability to function independently
Familiar with Health Care definitions or acronyms
Perform duties accurately and expediently in a deadline oriented environment
Contributes to team effort by accomplishing related results as needed
Time Management – managing one’s own time to ensure timeliness metrics are met
Escalate system-wide issues, deficiencies, problems and opportunities for improvement and offer recommendations for solutions
Assist with other applicable and support projects as needed
Participate in training sessions to better understand the functionality of the system
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.
Work with CAQH to obtain provider fall out and non-responders as part of provider outreach
Strictly observe the Fallon Health policy regarding confidentiality of member or provider information
High School Diploma; Associate’s degree or advanced education preferred
Resources used in performing roles :
QNXT, eVIPS, CAQH, OBCC Tool
2+ years’ experience in a call center environment, health care experience strongly preferred.
Proficiency with call center work flow and data entry.
Experience with relational databases.
Knowledge of Access and other Microsoft programs to track, update and analyze data.
Strong verbal and written communication skills.
Must be able to work a high volume, fast paced, goal-orientated environment with quality
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 1 month ago (9/15/2020 12:18 PM)
Job ID 6063
# Positions 1
Category Customer Service