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Fallon Health Provider Directory Compliance Manager in Worcester, Massachusetts


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.

The Provider Directory Compliance Manager position works in Office in Worcester, MA 3 days/week + 2 days/week at home.

Brief summary of purpose :

TheProvider Directory Compliance Manager manages Provider Data Management team. TheProvider Directory Compliance Manager develops and builds successful procedures to conduct provider outreach, data validation and updates into Core Record keeping system. TheProvider Directory Compliance Manager responds 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. TheProvider Directory Compliance Manager manages corporate key performance indicators. Implement and/or modify core record keeping system to deliver and maintain accurate provider data.


Primary Job Responsbilities (Include duties that represent 5% or more of employee's time)

  • Responsible for hiring, developing, and retaining the highest quality Provider Data Specialists as needed.

  • Regularly analyze and report on the productivity and 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.



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 work flow

  • 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


  • Qnxt

  • Evips

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 2 weeks ago (1/4/2022 4:22 PM)

Job ID 6683

# Positions 1

Category Provider Relations