The Provider Directory Specialist position requires to work in the Worcester, MA office Tuesday, Wednesday and Thursdays and allows work from home on Mondays and Fridays.

About us:

Fallon Health is a company that cares. We prioritize our members—always—making sure they get the care they need and deserve. Founded in 1977 in Worcester, Massachusetts, Fallon Health delivers equitable, high-quality, coordinated care and is continually rated among the nation’s top health plans for member experience, service, and clinical quality. We believe our individual differences, life experiences, knowledge, self-expression, and unique capabilities allow us to better serve our members. We embrace and encourage differences in age, race, ethnicity, gender identity and expression, physical and mental ability, sexual orientation, socio-economic status, and other characteristics that make people unique. Today, guided by our mission of improving health and inspiring hope, we strive to be the leading provider of government-sponsored health insurance programs—including Medicare, Medicaid, and PACE (Program of All-Inclusive Care for the Elderly)— in the region. Learn more at fallonhealth.org or follow us on Facebook, Twitter and LinkedIn.

Brief Summary of purpose:

The Provider Directory Specialist is responsible for a variety or Provider Data reviews from multiple sources, configuration and processing of exception reporting, resulting in Provider Directory compliance.

Primary summary of purpose: 

• Develop and document a robust end-to-end process to support CAQH data. Includes the analysis of data, configuration and automation into applicable systems, formal training documentation and policies and procedures and the processing of exception files.  Work in collaboration with IT to develop business rules supporting automation.
• Develop and document a robust end-to-end process to support MCE state data. Includes the analysis of data, configuration and automation into applicable systems, formal training documentation and policies and procedures and the processing of exception files.  Work in collaboration with IT to develop business rules supporting automation.
• Process all necessary data configuration updates timely and within established Service Level Agreements.
• Work closely w/Manager to develop necessary productivity, quality and management reporting.
• Perform duties accurately and expediently in a deadline-oriented environment
• Contributes to team effort by accomplishing related results as needed and performing ongoing evaluation of processes for future efficiencies.
• Time Management – managing one’s own time to ensure timeliness metrics are met independently
• Escalate system-wide issues, deficiencies, problems and opportunities for improvement and offer recommendations for solutions
• Assist with other applicable and support projects as assigned by management
• Participate in training sessions to better understand the functionality of the system
• 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.
• Develop strong partnership with Provider Relations for ongoing Provider education resulting in for accurate data
• Perform other duties as assigned by management

Education:

Associates degree or advanced education preferred

Experience: 

• 4+ years’ experience with Provider data
• Health care experience required
• Proficiency with data entry.
• Experience with relational databases
• Knowledge of Access, Excel and other Microsoft programs to track, update and analyze data.
• Strong verbal and written communication skills.
• Must be able to work a high volume, fast paced, goal-orientated environment with quality
• Proven ability to function independently

Fallon Health provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.