Fallon Health

  • Member Service Rep - Growing MLTC -

    Location US-NY-Amherst, NY
    Posted Date 1 month ago(7/19/2018 2:48 PM)
    Job ID
    5315
    # Positions
    1
    Category
    Customer Service
  • Overview

    Fallon Health Weinberg is a partnership between Fallon Health of Massachusetts and Weinberg Campus of Erie County, New York. Fallon Health Weinberg offers a Program of All-Inclusive Care for the Elderly (PACE) and a Managed Long Term Care (MLTC) plan to serve the health needs of dual-eligible residents of the Western New York counties of Erie and Niagara. Fallon Health Weinberg expands the choices that residents of Erie and Niagara Counties have when it comes to high-quality, affordable health care.

    Founded in 1977, Fallon Health provides health care services designed to meet the unique and changing needs of all they serve. It consistently ranks as one of the nation's highest-rated health plans, according to the National Committee for Quality Assurance (NCQA).* Fallon Health coordinates care with its Senior Care Options/Special Needs Plan for dual-eligible people who are 65 and older. Fallon Health has operated a PACE program in Massachusetts for more than 20 years and is the largest PACE program in New England and sixth largest nationally.**

     

    Weinberg Campus has been providing needed services to the elderly for more than 100 years, through both community-based programs and nursing facility care. It is a renowned geriatric education and training institution offering the widest range of housing and care options available on one campus.

    The two parent companies, Fallon Health and Weinberg Campus, have demonstrated consistent commitment to providing an array of solutions that make high-quality, integrated and affordable care more accessible to the poor, disabled and senior populations within the communities they serve.

     

    To provide the members of the managed long term care plan with  assistance as needed with benefits, authorizations, and communications.

    Responsibilities

    • Responsible for coordinating services with providers, authorizations while working with care managers, members and providers for support.
    • Processing and tracking enrollment and disenrollment documents, to include submissions to outside agencies as needed.
    • Maintaining logs and reports
    • Responsible for compiling and maintaining member information
    • Establishes and maintains a system for inventory control of medical supplies.
    • Answering telephones, taking messages, and directing calls.
    • Utilizes Word, Excel, Access and PowerPoint proficiently
    • Enhances the program’s professional image through courteous, cooperative, and knowledgeable interactions with all individuals both internal and external while representing Fallon Health Weinberg
    • Other duties as assigned

    Qualifications

    High School Diploma or Associates Degree preferred

    2-3 years experience in an office setting, preferable in the Health Care Industry.

    Knowled

     

    • Knowledge of medical terminology
    • Customer service experience preferred
    • Organizational skills required
    • Experience with Health Insurance/Medicaid—Preferred
    • Excellent computer skills required, including Windows, Word, Excel,
    • Excellent communication and organizational skills.
    • Ability to complete multiple tasks simultaneously.
    • Ability to work with people from various socio-cultural backgrounds in an effective manner.
    • Ability to work independently.         

    • Has full and complete access to member information and reports where utmost integrity is required to safeguard member and/or program and, which if disclosed, would have adverse effects.

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