Fallon Health

  • Provider Data Auditor - Growing Health Care Org!

    Location US-MA-Worcester
    Posted Date 3 weeks ago(7/31/2018 11:32 AM)
    Job ID
    5326
    # Positions
    1
    Category
    Provider Relations
  • Overview

    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:

    Under the general supervision of the Provider Data Manager, will perform an audit sampling of Provider Data within the eVIPS application. Prepares audit summaries and sign off for staff and managers. Identifies trends in errors and recommends improved processes and/or training needs.    

    Responsibilities

    • Reviews configuration of providers in the eVIPS application for accuracy
    • Organizes and prioritizes workload to meet audit timeframes.
    • Provides audit scoring results to management and staff.
    • Identifies and documents errors and trends for monthly metrics.
    • May provide assistance with training based on system modifications and or new processes.
    • Works independently but also is supportive of the team goals.
    • Serve as a subject matter expert and provide peer support in a mentoring or collaborative capacity in the office environment, whether it be training or answering of questions, as deemed appropriate by management.

    Resources (systems, etc) used in performing role

    • eVIPS
    • QNXT
    • Access
    • Excel
    • Audit Scoring Tools

    Qualifications

    Education:

    Bachelor’s degree preferred and/or similar work experience

     

    Experience:

    Minimum of 3 years’ experience in health care and 2-3 years in an auditing or analytical related field. Proficiency in Excel and Access including experience in comparing files. Knowledge of provider data.

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