Healthcare Service Liaison

2 weeks ago

Worcester, Massachusetts, United States Fallon Community Health Plan, Inc. Full time
Position Overview:

The Healthcare Service Liaison operates Monday through Friday from 8 AM to 5 PM. Initial training will be conducted in-office for a minimum of six months, followed by a hybrid work model requiring two days in the office and three days remotely.


About Fallon Community Health Plan, Inc.:
At Fallon Community Health Plan, we are dedicated to the well-being of our members. Our mission is to ensure that individuals receive the healthcare services they require and deserve.

Established in 1977, we are recognized for delivering equitable, high-quality, and coordinated healthcare, consistently ranking among the top health plans in the nation for member satisfaction, service, and clinical excellence.

We value diversity and believe that our unique backgrounds, experiences, and perspectives enhance our ability to serve our members effectively.

We are committed to fostering an inclusive environment that respects differences in age, race, ethnicity, gender identity, physical and mental abilities, sexual orientation, socio-economic status, and other characteristics that contribute to individuality.

Guided by our mission to improve health and inspire hope, we aim to be the foremost provider of government-sponsored health insurance programs in the region.


Key Responsibilities:

Under the supervision of the Manager of Prior Authorization, the Healthcare Service Liaison will:

  • Engage with both contracted and non-contracted facilities, agencies, and providers to gather essential data related to prior authorization requests.
  • Support the authorization workflow by processing incoming requests via various communication methods and entering service request information into the core system.
  • Handle incoming inquiries from multiple call lines, providing accurate information regarding policies, procedures, and benefits to both providers and members.
  • Collaborate with other departments to facilitate the processing of authorization information, ensuring timely access to medical services for members and accurate claims for providers.
  • Interpret and triage information to ensure compliance with regulatory standards and maintain the quality of the authorization process.

Authorization Duties:

The Healthcare Service Liaison will:

  • Receive and process authorization requests for members, verifying eligibility and existing coverage.
  • Input requests into the core system and update authorization records based on determinations made by the authorization team.
  • Manage a high volume of daily authorization entries, adhering to performance targets set by management.
  • Prepare and maintain authorization records in accordance with company policies.
  • Assist with departmental processes, including error reporting and notification generation.

Communication Responsibilities:

The role requires effective communication with:

  • Facilities and providers to relay pertinent information regarding care episodes and authorization statuses.
  • Internal teams to ensure all aspects of the authorization process are addressed.
  • Members and providers, delivering exceptional customer service and support.
  • Primary Care Provider (PCP) offices to educate them on new authorization procedures and address inquiries related to benefits and claims.

Qualifications:

Education: An Associate's Degree is preferred, with advanced education being highly desirable.

Experience: A minimum of two years of office experience, ideally within a managed healthcare setting. Familiarity with medical terminology, data entry, and computer systems is essential. Strong telephone and organizational skills are required.

Professional Attributes: The ideal candidate will demonstrate mature judgment, maintain confidentiality, and possess the ability to identify when to seek guidance or escalate issues.

Fallon Community Health Plan, Inc. is an equal opportunity employer, committed to fostering a diverse and inclusive workplace. We prohibit discrimination and harassment of any kind, ensuring a respectful environment for all employees and applicants.

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