Fallon Health Provider Data Specialist - Growing Healthcare Organization 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.

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.

Responsibilities

  • 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.

  • Strictly observe the Fallon Health policy regarding confidentiality of member or provider information

Qualifications

Education:

High School Diploma; Associate’s degree or advanced education preferred

License/Certifications:

N/A

Experience:

  • 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

Job ID 5433

# Positions 1

Category Provider Relations