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