Service Coordinator

5 days ago

Worcester, Massachusetts, United States Fallon Health Full time
About Fallon Health

Fallon Health is a company that cares. We prioritize our members' needs and deliver equitable, high-quality, coordinated care. As a leading provider of government-sponsored health insurance programs, including Medicare, Medicaid, and PACE, we strive to be the best in the region.

Job Summary

We are seeking a highly organized and detail-oriented Service Coordinator to join our team. The successful candidate will be responsible for communicating with facilities, agencies, and providers to collect pertinent data and disseminate information to support the authorization process.

Key Responsibilities
  • Accept and process authorization service requests, ensuring member eligibility and active insurance coverage.
  • Initiate entry of requests into the core system (QNXT/TruCare) and case management application (TruCare) as applicable.
  • Update authorization information in QNXT based on determinations made by Authorization Coordinators, Nurse Reviewers, and/or Nurse Care Specialists.
  • Handle a high volume of daily auth entries into the core system (QNXT).
  • Prepare completed authorization records for filing in accordance with company record retention policy.
  • Assist with departmental auto fax process, including running error reports and missing Fax # report on a daily basis.
  • Generate notifications to members, facilities, and agencies according to established protocol.
  • Interface with other FCHP departments to obtain and verify information relevant to pre-authorization requests.
  • Distribute departmental facsimiles and manage applicable queues in both the core system (QNXT UM and Call Tracking) and the case management application (TruCare).
Requirements
  • Associates Degree preferred; some advanced education highly preferred.
  • Two+ years of office experience, preferably in a managed healthcare environment, call center experience helpful.
  • Knowledge of medical terminology required; computer literacy and data entry experience required.
  • Excellent telephone, typing, and computer skills.
  • Self-starter with excellent organizational and listening/oral communication skills.
  • Mature judgment with the ability to maintain high degree of confidential/privileged patient and proprietary business information.
  • Computer skills in QNXT, Trucare, Excel, and Word.
Equal Employment Opportunity

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.

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