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About us:
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 nations 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. Learn more at fallonhealth.org or follow us on Facebook, Twitter and LinkedIn.
Brief Summary of Purpose:
The Fallon Health (FH) authorization process is an essential function to FHs compliance with CMS regulations, NCQA standards, other applicable regulatory requirements, and customer expectations. The FH Authorization Coordinator serves to administer the FH prior authorization process as outlined in the Plan Member Handbook/Evidence of Coverage, departmental policies and procedures, and regulatory standards. The Authorization Coordinator serves as a liaison between FH members and/or provider offices and FH with their authorization management issues. Thorough research, documentation, and corrective action planning must be established for each respective case and adjudication completed in accordance with existing regulations, policies, and standards.
Responsibilities:Primary Job Responsibilities:
Education:
High School Diploma; College degree (B.S. or B.A.) or equivalent preferred
License/Certifications:
Medical Terminology or Medical Coding helpful
Experience:
Resources:
QNXT, TruCare
COVID-19 Vaccination:
With the end of the Global Coronavirus COVID-19 Pandemic, Fallon Health no longer requires all employees to be vaccinated against COVID-19 except for employees who are in jobs that under state and federal laws, regulations and policies are required to be vaccinated and/or they are in Member/participant facing positions.
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.
Full Time
$35k-44k (estimate)
06/29/2024
07/12/2024
fallonhealth.com
Charlton, MA
<25
The following is the career advancement route for Authorization Coordinator positions, which can be used as a reference in future career path planning. As an Authorization Coordinator, it can be promoted into senior positions as a Patient Referral Specialist that are expected to handle more key tasks, people in this role will get a higher salary paid than an ordinary Authorization Coordinator. You can explore the career advancement for an Authorization Coordinator below and select your interested title to get hiring information.