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Service Coordinator
•30 days ago
| Hours | Full-time |
|---|---|
| Location | Worcester, MA Worcester, Massachusetts |
About this job
Job ID: 3982
# Positions: 1
Posted Date: 1/13/2015
Category: Care Coordination
Product Line: Summit ElderCare
Overview:
About 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 the only health plan in Massachusetts to have been awarded "Excellent" Accreditation by the National Committee for Quality Assurance for its HMO, Medicare Advantage and Medicaid products. For more information, visit www.fallonhealth.org.
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 social support and most medical services at a Summit ElderCare site while they keep the independence of living in their own homes and communities.
Position Overview:
Provides program wide coordination, scheduling and problem resolution for all approved home care services for SE participants. Conducts claim payment audits and facilitates resolution of identified issues. 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 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.
* 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 vendors and staff.
* Maintains an accurate electronic record of participants' home care services in a designated format.
* Reviews all invoices from non-contracted vendors for accuracy and facilitates timely payment. Facilitates resolution of identified issues.
* 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.
* Performs photocopying, faxing and other clerical duties as required.
Qualifications:
Education: High School diploma or equivalent
Experience: Past home care experience highly desirable. Previous customer service experience preferred.
Good MS Excel skills are key to this role and we will need to assess your ability to create a spreadsheet, sort data and insert rows and columns. You will not to do anything much more detailed than that in Excel.
Apply Here: http://www.Click2Apply.net/6nszyd2
PI87973142
# Positions: 1
Posted Date: 1/13/2015
Category: Care Coordination
Product Line: Summit ElderCare
Overview:
About 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 the only health plan in Massachusetts to have been awarded "Excellent" Accreditation by the National Committee for Quality Assurance for its HMO, Medicare Advantage and Medicaid products. For more information, visit www.fallonhealth.org.
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 social support and most medical services at a Summit ElderCare site while they keep the independence of living in their own homes and communities.
Position Overview:
Provides program wide coordination, scheduling and problem resolution for all approved home care services for SE participants. Conducts claim payment audits and facilitates resolution of identified issues. 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 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.
* 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 vendors and staff.
* Maintains an accurate electronic record of participants' home care services in a designated format.
* Reviews all invoices from non-contracted vendors for accuracy and facilitates timely payment. Facilitates resolution of identified issues.
* 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.
* Performs photocopying, faxing and other clerical duties as required.
Qualifications:
Education: High School diploma or equivalent
Experience: Past home care experience highly desirable. Previous customer service experience preferred.
Good MS Excel skills are key to this role and we will need to assess your ability to create a spreadsheet, sort data and insert rows and columns. You will not to do anything much more detailed than that in Excel.
Apply Here: http://www.Click2Apply.net/6nszyd2
PI87973142
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