About the position

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: The Program Coordinator is accountable for the daily management and coordination of MassHealth services. The responsibilities include working closely with the Manager, 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
• Performs both administrative and professional duties supporting ACO Partners
• Assisting with the management of daily operational activities
• Develop and maintain a departmental schedule for state meetings, detailing purpose and confirmed attendees

Requirements

• BA or BS or comprehensive training and experience within a managed care setting preferred
• 5 years’ experience in managed care, government programs or health care.
• Demonstrated strong organizational skills
• Demonstrated strong interpersonal skills