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 or purpose: 

This role will support the NDM contracting process with hospitals, physicians and ancillary providers.   This includes working with provider contract management software to assist in the timely implementation of contracts and improving the throughput of the contract implementation process.  Interactions with non-contracted providers requesting a contract will be required, as well as working with Contract Managers and NDM Management in support of strategic initiatives.   

Primary Job Responsibilities: 

• Assists in maintaining and managing Network Provider Contract Database (EVIPS) for Hospitals, Provider Groups and Ancillary providers including Individual Provider Agreements 
• Assists in ensuring accuracy with contract terms, provider rates, effective dates & other EVIPS contract entry requirements
• Process Provider Letter of Interests by either issuing Network-Closed letters to providers or pulling appropriate documentation to assist assigned Contract Manager in issuing Provider Agreements
• Process Individual Provider Agreements by collecting on-boarding information (e.g. W-9, Confidentiality Agreements & Provider Rosters)
• Process Single Case Agreements and enter claim pricing in QNXT system
• Assist with and support NDM’s Contracting Network-Build or other initiatives as needed by for example, preparing Health Service Agreements/Amendments and managing EVIPs entry workflow
• Collaborate with intra and interdepartmental areas including NDM Operations, Credentialing Department, Provider Configuration and Provider Data Services, as needed
• Ability to complete necessary tasks for NDM associated with and required to move projects to timely and successful completion
• Supports NDM dashboard effort by tracking outcomes/success metrics and ensures accurate and timely reporting of key metrics
• Actively pursues continued development / enhancement of skill set
• Performs other duties as assigned

• Requires experience working with cross-functional teams and competing priorities
• Proficient in Microsoft Windows based office applications to include Excel, Word, PowerPoint, and SharePoint
• Experience with eVIPS software and QNXT Trizetto platform desirable

Pay Range Disclosure:
In accordance with the Massachusetts Wage Transparency Act, the pay for this position is $60,000-$ 63,000 annually which reflects what we reasonably and in good faith expect to pay at the time of posting. Final compensation will depend on the candidate’s experience, skills, and fit with the role’s responsibilities

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.