Fallon Health
Program Support Coordinator
Fallon Health - Worcester, Massachusetts, United States, 01602
Work at Fallon Health
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Overview
Clinical Integration Program Support Coordinator
Fallon Health is a company that cares. We prioritize our membersalwaysmaking sure they get the care they need and deserve. Founded in 1977 in Worcester, Massachusetts, Fallon Health delivers equitable, high-quality, coordinated care and is continually rated among the nation's top health plans for member experience, service, and clinical quality. We believe our individual differences, life experiences, knowledge, self-expression, and unique capabilities allow us to better serve our members. We embrace and encourage differences in age, race, ethnicity, gender identity and expression, physical and mental ability, sexual orientation, socio-economic status, and other characteristics that make people unique. Today, guided by our mission of improving health and inspiring hope, we strive to be the leading provider of government-sponsored health insurance programsincluding Medicare, Medicaid, and PACE (Program of All-Inclusive Care for the Elderly)in the region. The Clinical Integration Program Support Coordinator's function and role assists the Clinical Integration staff in providing care management services to Fallon Health member populations. The Program Support Coordinator performs valuable 'back office' functions that support and enable the various roles in the department to outreach and work with member populations. Duties include but are not limited to: Receives incoming member completed health risk assessment tools including but not limited to ACO member Care Needs Screenings and keypunching details in the documentation system, and assigns members for outreach based upon member responses to trigger questions Receives incoming member referrals and utilizing the documentation system to assign member for Care Team outreach in the various available Clinical Integration Team Programs Receives NaviCare member enrollment notifications (enrollment/disenrollment) from the Operations Team and communicates this information to the clinical team for outreach utilizing established processes. Creates NaviCare member authorizations in the TruCare system for member admissions to long term care facilities for short term and custodial care Manages medical records request Processes all incoming/outgoing member mail generated by the Care Team staff and ACO partners with accuracy Manages incoming faxes and member specific data, routing to the appropriate Care Team member Produces, manipulates, and maintains various reports utilized by the Clinical Integration Teams to manage and facilitate member care Produces, manipulates, and sends monthly ASAP rosters with NaviCare membership ensuring accuracy in data regarding member status Supports the Clinical Integration Team with data reconciliation efforts including but not limited to entering data into the QXNT and TruCare systems to ensure accuracy in reporting Manages incoming requests from vendors/ASAPs/providers for access to the TruCare Documentation system performing reconciliations with vendors/ASAPs/providers Manages deactivation for vendor/ASAP/provider TruCare users when access no longer required in conjunction with I.T. department Manages deactivation for ACO TruCare users when access no longer required in conjunction with I.T. department Generates and updates rosters of vendor/ASAP/provider TruCare users Receives and processes incoming vendor invoices ensuring members receiving services at such point in time have active membership Provides back up to Team members and is fully trained in all functions completed by the Clinical Integration Support Team Demonstrates a detailed working knowledge of the TruCare documentation system as well as Fallon Health's core system QNXT In coordination with the Administrative Assistant, manages the supplies inventory for paper, and copier supplies, etc. Manages the communication of ACO care plans to the members and their PCPs. Provides additional support to the ACO Community Partner (CP) and Flex Program Coordinator as needed and directed by Supervisor/Manager 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.
Fallon Health is a company that cares. We prioritize our membersalwaysmaking sure they get the care they need and deserve. Founded in 1977 in Worcester, Massachusetts, Fallon Health delivers equitable, high-quality, coordinated care and is continually rated among the nation's top health plans for member experience, service, and clinical quality. We believe our individual differences, life experiences, knowledge, self-expression, and unique capabilities allow us to better serve our members. We embrace and encourage differences in age, race, ethnicity, gender identity and expression, physical and mental ability, sexual orientation, socio-economic status, and other characteristics that make people unique. Today, guided by our mission of improving health and inspiring hope, we strive to be the leading provider of government-sponsored health insurance programsincluding Medicare, Medicaid, and PACE (Program of All-Inclusive Care for the Elderly)in the region. The Clinical Integration Program Support Coordinator's function and role assists the Clinical Integration staff in providing care management services to Fallon Health member populations. The Program Support Coordinator performs valuable 'back office' functions that support and enable the various roles in the department to outreach and work with member populations. Duties include but are not limited to: Receives incoming member completed health risk assessment tools including but not limited to ACO member Care Needs Screenings and keypunching details in the documentation system, and assigns members for outreach based upon member responses to trigger questions Receives incoming member referrals and utilizing the documentation system to assign member for Care Team outreach in the various available Clinical Integration Team Programs Receives NaviCare member enrollment notifications (enrollment/disenrollment) from the Operations Team and communicates this information to the clinical team for outreach utilizing established processes. Creates NaviCare member authorizations in the TruCare system for member admissions to long term care facilities for short term and custodial care Manages medical records request Processes all incoming/outgoing member mail generated by the Care Team staff and ACO partners with accuracy Manages incoming faxes and member specific data, routing to the appropriate Care Team member Produces, manipulates, and maintains various reports utilized by the Clinical Integration Teams to manage and facilitate member care Produces, manipulates, and sends monthly ASAP rosters with NaviCare membership ensuring accuracy in data regarding member status Supports the Clinical Integration Team with data reconciliation efforts including but not limited to entering data into the QXNT and TruCare systems to ensure accuracy in reporting Manages incoming requests from vendors/ASAPs/providers for access to the TruCare Documentation system performing reconciliations with vendors/ASAPs/providers Manages deactivation for vendor/ASAP/provider TruCare users when access no longer required in conjunction with I.T. department Manages deactivation for ACO TruCare users when access no longer required in conjunction with I.T. department Generates and updates rosters of vendor/ASAP/provider TruCare users Receives and processes incoming vendor invoices ensuring members receiving services at such point in time have active membership Provides back up to Team members and is fully trained in all functions completed by the Clinical Integration Support Team Demonstrates a detailed working knowledge of the TruCare documentation system as well as Fallon Health's core system QNXT In coordination with the Administrative Assistant, manages the supplies inventory for paper, and copier supplies, etc. Manages the communication of ACO care plans to the members and their PCPs. Provides additional support to the ACO Community Partner (CP) and Flex Program Coordinator as needed and directed by Supervisor/Manager 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.