Fallon Health

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Medicare Plan Documents & Project Coordinator - 28 hours/week

Medicare Plan Documents & Project Coordinator - 28 hours/week

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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.


Brief summary of purpose:

This position is responsible for distributing and tracking regulatory and sub-regulatory guidance from CMS to ensure timeliness and applicable deadlines are met; this includes items such as Announcement & Call Letter, manual revisions, guidance communicated by CMS during contractor conference calls, and HPMS memos. Assist with the submission of marketing materials as delegated as well as assisting with special projects. Support Medicare Programs to coordinate, gather and submit required elements of CMS audits and reviews; this includes working with departments throughout Fallon as necessary and acting as the lead audit contact for Fallon. Coordinates and manages as delegated the development of all Medicare Advantage Evidence of Coverage (EOC), Annual Notice of Changes (ANOC), Schedule of Benefits (SBs) and Low-Income Subsidy (LIS) Rider documents. Assists with the oversight of HPMS’ Complaints Tracking Module (CTM) for appropriate and timely responses with the CMS-defined timelines.


  • Distribute and track all memos received from CMS via HPMS, including summary analysis, distribution to business owners, impact on operations, and any associated deadlines. This may include following up with Medicare Programs’ subject matter experts as needed to help ensure implementation and deadlines are met.
  • Support Medicare Programs to coordinate, gather and submit required elements of CMS audits and reviews. This includes working with departments throughout Fallon as necessary. This may also include acting as Fallon’s audit lead, such as for a CMS Financial Audit.
  • Assist with the oversight of HPMS’ CTM, including the review of drafted Customer Service responses in partnership with other Medicare Programs staff.
  • Develop and maintain EOCs, ANOCs, SBs for EGWPs, and LIS Riders. Ensures that documents are completed in an accurate and timely fashion, and comply with all regulatory requirements. CMS imposes strict deadlines on the production and mailing of these documents. The creation of these documents involves very detailed, complex and time consuming formatting. This includes developing new plan documents to support new plan types.

  • For plan documents: identify changes in the CMS models compared to previous year documents. Work with departments to develop required language to complete the documents. Ensure all documents are accurate and complete by the required deadlines.
  • Assist with the submission of certain marketing materials, such as File and Use.
  • Maintain basic knowledge and understanding of the Medicare Managed Care Manual (MMCM): Medicare Marketing Guidelines (Chapter 3), SCO marketing requirements, and PACE Chapter 3 Marketing Guidelines, as well as other MMCM and Medicare Prescription Drug Benefit Manual (MPDBM) chapters that impact materials.
  • Maintain basic knowledge of MMCM Chapters 2 and 13, MPDBM Chapters 4, 13, and 18 to assist with the oversight of the CTM and marketing materials.
  • Support the completion of the required yearly Plan Benefit Package (PBP) as needed.
  • Responsible for assisting in the maintenance of applicable policies and procedures, such as marketing, CTM, and HPMS memo distribution.
  • Participate in CMS user group calls.
  • Assist with the oversight of Part C & D reporting quality review of entered data. Support the required yearly Part C & D Data Validation process with Fallon’s external vendor.




Bachelor’s degree in business, health care or related area or equivalent job experience



  • 2 years managed care or relevant industry experience
  • 2 years Medicare Advantage experience preferred

Fluency in Microsoft Office. Strong ability to develop and implement tracking tools for regulatory memos. Possess excellent communication skills with the ability to write clearly and concisely, and interact with a wide range of professional levels. Time management and organizational skills are an extremely important aspect to this position due to the strict deadlines imposed by government agencies. Strong attention to detail a must.