Healthcare Service Management Associate

3 days ago


Worcester, Massachusetts, United States Fallon Health Full time
Job Title: Healthcare Service Management Associate

Estimated Salary: $58,000 - $68,000 per year

About Us: Fallon Health is committed to delivering high-quality, patient-centered care. Our team is dedicated to working collaboratively with our patients, providers, and partners to improve health outcomes and inspire hope.

Job Description:

  • We are seeking a highly motivated and detail-oriented Healthcare Service Management Associate to join our team. The successful candidate will work closely with our authorization coordinators to ensure efficient and effective processing of medical authorizations.
  • As a Healthcare Service Management Associate, you will be responsible for managing the authorization process, communicating with providers and patients, and resolving complex issues.
  • You will also be handling incoming calls from multiple ACD lines, addressing customer inquiries, and providing direction regarding plan policies and procedures.
  • The ideal candidate will have excellent communication and problem-solving skills, with the ability to maintain high levels of confidentiality and professionalism.

Key Responsibilities:

  1. Manages the authorization process, including initiating entry of request(s) into core system (QNXT/TruCare) and case management application (TruCare) as applicable.
  2. Handles an appropriately high volume of daily auth entries into the core system (QNXT).
  3. Prepares completed authorization records for filing in accordance with company record retention policy.
  4. Assists with departmental auto fax process, including running error reports and missing Fax # report on a daily basis as assigned.
  5. Interfaces with other FCHP departments to obtain and verify information relevant to pre-authorization requests.

Qualifications:

  • Bachelor's degree or equivalent experience in healthcare administration or a related field.
  • At least 2 years of experience in a managed healthcare environment, preferably in a call center setting.
  • Excellent communication, problem-solving, and time management skills.
  • Able to maintain high levels of confidentiality and professionalism.


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