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Fallon Health ACO Program Coordinator in Worcester, Massachusetts

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 accredited by the National Committee for Quality Assurance for its HMO, Medicare Advantage and Medicaid products. For more information, visit fallonhealth.org.

Summary of purpose:

The ACO Program Coordinator is accountable for the daily management and co-ordination of MassHealth services. The responsibilities include working closely with the Director, ACO Product Management on the maintenance, monitoring and reporting for all programs and operations as required for the ACO Program. The coordinator serves as the Key Contact for MassHealth and assists with the day to day functions within MassHealth Programs.

Responsibilities

  • Act as liaison between Fallon and MassHealth and have the following responsibilities

  • Ensure compliance with the provisions of the MassHealth contracts including the timely submission of all department, special project, and organization reports.

  • Monitor the status of reporting deliverables to the state and escalate any issues associated with submissions to the Director, ACO Programs.

  • Act as organizational resource for contractual and benefit questions associated with the MassHealth program and products.

  • Develop and maintain a collaborative working relationship as key contact (liaison) between Fallon and MassHealth

  • Coordinate and ensure timely response to all inquiries and requests received from MassHealth, working collaboratively with all departments within Fallon Health

  • Review, approve, and coordinate the submission of documents requiring MassHealth approval.

  • Review all state communication to the Key Contact, identify the appropriate impacted internal departments, ensure receipt of information and provide direction if action is to be taken on the part of Fallon Health.

  • Develop and maintain a system for continually tracking and monitoring the approval cycle for all documents

  • Maintain Fallon’s data within MassHealth’s Virtual Gateway

  • Manage the Provider Maintenance process between Fallon, MassHealth and ACO Partners

  • Ensure Appropriate Fallon Representation for any MassHealth meeting

  • Assist in the day to day operations of the MassHealth Programs Department:

  • Coordinate ACO partner meetings and assists with facilitation

  • Performs both administrative and professional duties supporting ACO Partners

  • Assisting with the management of daily operational activities

  • Maintain the Fallon ACO Sharepoint site

  • Develop and maintain a departmental schedule for state meetings, detailing purpose and confirmed attendees

Qualifications

Education

BA or BS or comprehensive training and experience within a managed care setting preferred

License/Cerfifications

N/A

Experience

5 years’ experience in managed care, government programs or health care.

Demonstrated strong organizational skills

Demonstrated strong interpersonal skills

Location US-MA-Worcester

Posted Date 1 month ago (1/21/2020 4:31 PM)

Job ID 5866

# Positions 1

Category Social Work

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