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 fallonhealth.org.
Brief summary of purpose:
The FH authorization process is an essential function to FH’s compliance with CMS regulations, NCQA standards, other applicable regulatory requirements and customer expectations. The FH Authorization Coordinator serves to administrate the FH pre-authorization process as outlined in the Plan Member Handbook/Evidence of Coverage, departmental policies and procedures, and regulatory standards. The Authorization Coordinator serves as a liaison between FH members and/or provider offices and FH with their authorization management issues. Thorough research, documentation, and corrective action planning must be established for each respective case and adjudication completed in accordance with existing regulations, policies and standards.
Transplant Coordinator duties (as assigned)
As a transplant authorization coordinator, the role must also sever as a liaison with the contracting department as well as a primary contact for Fallon’s re-insurance vendor. The Transplant Coordinator performs and tracks the FH authorization process as it relates to all services for transplants including pre-transplant evaluations, actual transplant services (admissions) and post-transplant follow-up services.
Transplant Coordinator Duties (as assigned):
Education: High School Diploma; College degree (B.S. or B.A.) or equivalent preferred
Certification: Medical Terminology or Medical Coding helpful