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 www.fallonhealth.org.
The Claims Processor should have a thorough knowledge of claim entry in the core and external vendor processing systems, as well as a general knowledge of claims processing. Responsible for claims corrections involving data entry errors in the data entry vendor’s queue, processing of member reimbursement requests and Customer Service cases, triage/assignment of requests for claim review and other claims documents, as well as other claims entry and processing tasks as assigned. Ensures member and provider satisfaction by providing appropriate and timely processing of claims. Must be able to work on tasks both independently and as part of a team.
High school diploma, college degree preferred. Medical billing and coding or equivalent experience preferred.
Resources (systesm, etc.) used in performing role:
MS Office, QNXT, Caremark, Smart Data Solutions, Burgess, Multiplan, FairHealth