UM Inpatient Service Coordinator

The UM Inpatient Service Coordinator is a telphonic role working with hospital offices regarding inpatient or hospital stays prior authorizations for members. This position is flexible remote working M - F 8:30 am to 5 pm.

About us:

Fallon Health is a company that cares. We prioritize our members-always-making 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 programs-including Medicare, Medicaid, and PACE (Program of All-Inclusive Care for the Elderly)- in the region. Learn more at fallonhealth.org or follow us on Facebook, Twitter and LinkedIn.

Brief Summary of Purpose:

Under the direction of the Supervisor, Inpatient Care Coordinator communicates with contracted and non-contracted facilities/agencies/providers and members to collect pertinent Acute Inpatient, Maternity and Post-Acute authorization request data and disseminates information to the Utilization Nurses for review. Additionally, supports the authorization process by receiving incoming faxed/mailed/emailed/etc. requests and initiates entry of service request shells into core system (TruCare and/or QNXT). Responsible for incoming calls for the UM department addressing and/or referring customer (provider/member) calls/inquiries, provide direction regarding Plan policies, procedures and when applicable, benefit information. Responsible for first level call resolution oversight. Interact with department's Manager to identify areas that need improvement or change and oversee implementation of change if applicable. Work in conjunction with other FH departments to assist in processing authorization information in order to facilitate the member's medical services or the providers' claims. Interprets and triages information to ensure appropriate action is initiated to meet regulatory bodies' standards and to maintain the quality and timeliness of the authorization process.

Job Responsibilities:

1-3 years' professional experience in related position, preferably in health care.
• Experience in a managed care or call center setting or physician's office; knowledge of managed care and/or utilization management strategies advisable
• High level competency with "customer service" phone skills
• Good writing skills with familiarity and comfort with medical terminology.
• Ability to work independently and make appropriate decisions within the realm of set business and benefit guidelines
• Good interpersonal communication and problem-solving skills.
• Experienced in understanding what is being asked during phone calls while researched for appropriate answers.
• Computer literate, particularly in Windows based applications (Word, Excel, PowerPoint, and Access).

Education:

• Associates Degree Preferred. Some advanced education highly preferred

Experience:

• 1-3 years' professional experience in related position, preferably in health care.
• Experience in a managed care or call center setting or physician's office; knowledge of managed care and/or utilization management strategies advisable
• High level competency with "customer service" phone skills
• Good writing skills with familiarity and comfort with medical terminology.
• Ability to work independently and make appropriate decisions within the realm of set business and benefit guidelines
• Good interpersonal communication and problem-solving skills.
• Experienced in understanding what is being asked during phone calls while researched for appropriate answers.
• Computer literate, particularly in Windows based applications (Word, Excel, PowerPoint, and Access).

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.

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