Healthcare Provider Support- Growing Senior Plan- No Nights No weekends

About us:

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, we deliver equitable, high-quality coordinated care and are continually rated among the nation’s top health plans for member experience, service, and clinical quality.

Fallon Health’s Summit ElderCare® is a Program of All-Inclusive Care for the Elderly–PACE for short. PACE, an alternative to nursing home care, is a program that helps people 55 and older continue living safely at home. At Fallon Health, we believe our individual differences, life experiences, knowledge, self-expression and unique capabilities allow us to better serve our members. We embrace and encourage differences in age, race, ethnicity, gender identity and expression, physical and mental ability, sexual orientation, socio-economic status and other characteristics that make people unique. 

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— in the region. 

Brief summary of purpose: 

Responsible for ensuring all Summit ElderCare Providers are effectively on-boarded, oriented, supported, and licenses maintained, with ongoing support for their daily activities. Represents Fallon Health’s Summit ElderCare PACE program with high level of professionalism both internally and externally. Under minimal supervision, independently works to complete multiple high-level operational and administrative projects and provides ongoing support of the VP/Medical Director, and all Summit ElderCare Providers; this may include but is not limited to provider onboarding, scheduling, credentialing, reporting and billing. 

Provider Onboarding (20% of time)

• Following a comprehensive Provider onboarding schedule, ensures each new provider is appropriately oriented to his/her new position/role.
• Creates and submits Service tickets for Provider access to the Electronic Health Record and other relevant applications, registering all SE providers in contracted hospital EHR systems so that they may have real-time access to SE participant medical records.
• Works with hospital staff to obtain provider medical records access for all contracted inpatient
• Assists with completing onboarding and Credentialing Paperwork (HCAS, SNF credentialing applications, registration documents to gain access to inpatient medical records systems, PECOS, Masshealth etc.).
• Coordinates with EHR trainer to ensure newly hired providers as well as existing providers are provided with appropriate level of instruction in electronic health record.
• Works collaboratively with Service Delivery team to ensure appropriate number of licenses for the Electronic Health Record.

  Ongoing Provider Support (45% of time)

• Receives, processes and keep track, in collaboration with the provider managers, of all provider time off requests.
• Coordinates time off requests for all SE providers in collaboration with the respective providers managers, Site Directors and/or Clinical Managers to ensure appropriate clinical site
• Assists SE Providers with Oracle expense reporting by submitting and tracking mileage and expense reimbursement requests.
• Processes CME registration and reimbursement A rranges related travel (hotel, air and ground transportation) when appropriate; tracks CME spend and reimbursements.
• Reviews all charges and creates 837 files for non-statistical claims processing for all SE Providers: reviews and processes EPM provider claims billing on a weekly basis.
• Manages the Provider On-Call Schedule and ensures any necessary changes are made in a timely manner and communicated to the answering service.
• Upon request from VP/medical director, works with other FH departments to obtain SE Provider- specific productivity, utilization or other
• Works with the SE sites to ensure that, monthly, Provider panels are validated and reconciled against QNXT reports for accurate provider assignments across the program and claims submission.
• Assists providers with credentialing and recredentialing in contracted rehab, long term care facilities, hospitals and other facilities when applicable.
• Attesting and reattesting CAQH on behalf of providers, when
• Maintains Providers orientation and information files and updates as
• Maintains Providers contact list and shares with each site and others as appropriate on a regular
• Maintains accurate and updated list of contact information for all contracted and relevant external facilities and personnel that support providers (Administrators, IT, etc.)
• Acts as point person for MA Medical Society and National PACE Association regarding membership & payment.
• Maintains Personnel files for all SE Provider Staff & other VP/Medical Director direct
• Provides support and calendar management for VP/Medical Director; other direct reports upon request by VP/Medical director.
• In collaboration with the VP/Medical Director, plans and coordinates monthly Provider Meetings; responsibilities include, but are not limited to, creating, and distributing the agenda, attending meetings, and recording and posting the minutes, setting up location if in-person (food, equipment, materials, etc.) or remote (video conferencing equipment, etc.)

Coordinating projects (35% of time)

• Tracks initiatives or projects as assigned by VP/medical director and senior leaders.
• Assists in identifying projects deadlines, sponsors, and desired outcomes.
• Coordinates with PACE site leaders and team members to make sure all parties are on track with project requirements, deadlines, and schedules.
• Meets with project team members and other stakeholders when needed to identify and resolve issues or report barriers.
• Assists in the development of training materials and other documents to ensure successful implementation.
• Assists in creating projects schedules and timelines.
• Prepares status report by gathering and summarizing relevant information.
• Provides project updates at defined intervals, in coordination with project sponsors.
• Ensures follow through, up to and including completion of projects with deliverables if applicable.
• Serves as point of contact for different team members involved in projects.
• Monitors workflow and communicates with team members, leaders, and other stakeholders on the status of tasks and workplan.

Other

• Completes all work in a timely manner as assigned by the SE VP/Medical Director and SE senior
• Completes other tasks, projects, and duties as

Education: 

Associate degree required; Bachelor degree or equivalent preferred

License/Certifications:

None Required

Experience:

• 3-5 years of administrative experience in a healthcare organization and /or providers medical group required.
• Preferred experience in or ability to quickly learn provider credentialing, onboarding, scheduling, and maintaining schedules and call calendars
• Understanding of clinical practice operations and medical terminology
• PACE center expereince desirable
• Skilled in gathering data, researching, preparing and presenting reports. 
• Must be willing to travel to all Summit Eldercare PACE sites for Provider support and assistance when needed,; Reliable transportation required. 
• Excellent communication skills, verbal and written. 
• Attention to details with superior organizational skills and time management. 
• Strong interpersonal skills
• Flexibility in adjusting to changing conditions & various details of the position. 
  • ability to multitask and prioritize competing demands
  • willingness and ability to adjust and respond urgently
  • skilled at working with a large and diverse group. 

Resources used in performing role:

Microsoft applications, Word, Excel, Outlook, Oracle, Visio, Nextgen, QNXT, Crystal,

COVID-19 Vaccination:

With the end of the Global Coronavirus COVID-19 Pandemic, Fallon Health no longer requires all employees to be vaccinated against COVID-19 except for employees who are in jobs that under state and federal laws, regulations and policies are required to be vaccinated and/or they are in Member/participant facing positions.

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.

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