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OverviewAbout 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.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.Responsibilities
Coordinates and schedules home care services to implement the plan of care established by the interdisciplinary team (IDT).
Works collaboratively with Home Care nurses and other staff, vendors, participants and families to support SE’s mission, promote high quality care and service as well as positive internal and external customer relations.
Communicates with homecare agencies and other vendors to coordinate services including initial orders, changes, cancellations and resumption of services.
Demonstrates professionalism and acts as an ambassador for Fallon Health and Summit ElderCare at all times
Emails or faxes open case needs to homecare agencies as required.
Effectively utilizes established systems and procedures to identify problem cases and alert management of need for additional interventions.
Follows up on all non-assigned cases as required until services are secured.
Documents all vendor authorizations and service coordination efforts in the EMR and other identified systems as assigned.
Documents all participant related telephone calls in the EMR.
Faciliates timely delivery of service authorizations to vendors.
Maintains a positive working relationship with peers, vendors and other staff.
Maintains an accurate record of participants’ home care services in a designated format.
Utilizes established systems to track data as assigned. Prepares reports as requested.
Conducts periodic audits of claims paid to ensure services were authorized by the IDT and facilitates resolution of identified issues.
Is expected to be a part of the weekend on call rotation.
Performs photocopying, faxing and other clerical duties as required.
Performs other duties as assigned by Operations Manager and other leadership staff.
QualificationsEducation, Licenses, certification and experience requirements:Education: High School diploma or equivalent Experience: Past home care coordination/scheduling experience highly desirable. Previous customer service experience preferred.
Excellent telephone and customer service skills
Relationship building skills
Strong organizational skills
Strong work ethic
Strong basic computer and office skills specifically with Microsoft Office
Ability to plan work and meet required deadlines
Ability to work in a fast paced environment
Basic math skills
Ability to learn insurance terminology related to authorizations, claims and payments
# Positions 1Category Customer Service
