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 www.fallonhealth.org.
Brief Summary of Purpose:
The Provider Data Specialist conducts outbound calls to providers to validate provider data in Fallon Health’s core record keeping system. Post validation, Provider Data Specialist will document calls taken identifying data changes obtained from provider. Provider Data Specialist will make required changes post documentation to provider records as required within service level agreements.
Key Accountabilities:
- Contact providers for updates to provider data
- Validate provider data
- Update provider data- determine completeness of forms prior to entry. Research any misleading or missing data fields and escalate any unresolved issues to Manager.
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:
In collaboration with business owners, provide training approach, design , develop and deliver blended (virtual, self-paced and classroom) course material using proven instructional design methodologies to multiple delivery channels. In addition to administrative and technical training support for assigned areas. Position includes a high degree of training to technical and non-technical staff of business requirements, process and service oriented responsibilities. Provide information on employee training and performance to senior management.
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 www.fallonhealth.org.
About Summit ElderCare:
Fallon Health operates the largest Program of All-Inclusive Care for the Elderly (PACE) in New England and the fifth largest in the country. Called Summit ElderCare, Fallon’s PACE helps provide older adults and their caregivers with a welcome alternative to nursing home care. Participants in Summit ElderCare have access to comprehensive medical services and social support at a Summit ElderCare site while they keep the independence of living in their own homes and communities.
Position Overview:
Provides coordination, scheduling and problem resolution for all approved home care services for SE participants. Documents all actions in a timely manner in an electronic medical record (EMR). Supports other program administration needs as assigned.