Talent.com
UM Service Coordinator - Hybrid - $22/hr
UM Service Coordinator - Hybrid - $22/hrFallon Community Health Plan, Inc. • Worcester, MA, US
UM Service Coordinator - Hybrid - $22 / hr

UM Service Coordinator - Hybrid - $22 / hr

Fallon Community Health Plan, Inc. • Worcester, MA, US
job_description.job_card.variable_days_ago
serp_jobs.job_preview.job_type
  • serp_jobs.job_card.full_time
job_description.job_card.job_description

Overview

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 Manager of Prior Authorization, communicates with contracted and non-contracted facilities / agencies / providers to collect pertinent prior authorization request data and disseminates information to the Authorization Coordinators. Additionally, supports the authorization process by receiving incoming faxed / mailed / emailed / etc. requests and initiates entry of service request shells into core system -TruCare. Responsible for incoming calls from the multiple ACD lines for the UM department addressing and / or referring customer (provider / member) calls / inquiries, provide direction regarding Plan policies, procedures and when applicable, benefit information. Work in conjunction with other Fallon Health 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.

Responsibilities

Job Responsibilities :

Authorization Functions

Accepts authorization service requests and notifications for FCHP members, screens for member eligibility, additional active insurance coverage and authorization history from the core system.

Initiates entry of request(s) into core system (QNXT / TruCare) and case management application (TruCare) as applicable.

Updates authorization information in QNXT because of determinations made by Authorization Coordinators, Nurse Reviewers and / or Nurse Care Specialists.

Handles an appropriately high volume of daily auth entries into the core system (QNXT). This volume target will be communicated to the staff on a regular basis by the Manager as business needs dictate.

Prepares completed authorization records for filing in accordance with company record retention policy.

Assists with departmental auto fax process including running error reports and missing Fax # report daily as assigned.

Generates notifications to members, facilities, and agencies according to established protocol (auto-fax notification process and auto-generated letter process from the core system

Interfaces with other FCHP departments to obtain and verify information relevant to pre-authorization requests (e.g. contract information, benefits, etc.), including authorization details when requested for appeals.

Distributes departmental facsimiles; checks Right Fax no less than hourly throughout the day; follows established process for determining to whom facsimiles are to be delivered; research facsimiles inappropriately addressed by using the core system (QNXT) or by communicating with appropriate individuals for assistance; redirects / saves facsimiles as indicated to the staff and / or G drive.

Manage applicable queues in both the core system (QNXT UM and Call Tracking) and the case management application (TruCare).

Enters / extends / changes approved authorizations within established parameters.

Communications

Communicates with contracted and non-contracted facilities / agencies / providers to collect pertinent data regarding an episode of care and give applicable policy information and / or authorization numbers and status to facility / agency.

Communicates with inter / intra departmental personnel about all aspects of the authorization process as requested.

Responsible to provide first response to inbound call center. Handles calls from providers and members with excellent customer service.

Assist FCHP providers, members and / or their recognized authorized representatives with questions and concerns regarding authorizations.

Manage the ACD hunt line and handle calls appropriately with a focus toward excellent customer service. In addition, the Service Coordinator will attain the targets for a customer service call center as set by FCHP. These targets will be communicated to the staff by the Manager.

Educates PCP offices on new authorization procedures as needed as well as answer benefit / claims / referral questions in support of the Customer Service function.

Manage the Call Tracking module in the core system (QNXT) as required.

Miscellaneous

Strictly observes the FCHP policy regarding confidentiality of member and provider information.

Handle other duties as assigned based on the needs of the business

Qualifications

Education :

Associate's degree Preferred. Some advanced education highly preferred.

Experience :

Two plus years office experience, preferably in a managed healthcare environment, call center experience helpful : knowledge of medical terminology required; computer literacy and data entry experience required

Excellent telephone, typing and computer skills

Self-starter (able to identify when specifically assigned functions have been completed and to request additional work)

Excellent organizational skills

Excellent listening / oral communication skills

Mature judgment : knows when to seek guidance / direction and or when to refer problems to management

Ability to maintain high degree of confidential / privileged patient and proprietary business information

Computer Skills (QNXT, Trucare, Excel, Word)

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.

Location US-MA-Worcester

Posted Date 2 days ago (10 / 1 / 2025 1 : 02 PM)

Job ID 8112

Positions

Category Other

J-18808-Ljbffr

serp_jobs.job_alerts.create_a_job

Um Coordinator • Worcester, MA, US

Job_description.internal_linking.related_jobs
Prior Authorization Service Coordinator - Hybrid - $22 / hr

Prior Authorization Service Coordinator - Hybrid - $22 / hr

Fallon Community Health Plan, Inc. • Worcester, MA, US
serp_jobs.job_card.full_time
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 equita...serp_jobs.internal_linking.show_more
serp_jobs.last_updated.last_updated_variable_days • serp_jobs.job_card.promoted
Student Services Coordinator

Student Services Coordinator

VirtualVocations • Worcester, Massachusetts, United States
serp_jobs.job_card.full_time
A company is looking for a Student Services Coordinator.Key Responsibilities Data entry and management of student information within the CRM platform Review and collect required student document...serp_jobs.internal_linking.show_more
serp_jobs.last_updated.last_updated_variable_days • serp_jobs.job_card.promoted
Colorado Licensed Behavioral Health Coordinator

Colorado Licensed Behavioral Health Coordinator

VirtualVocations • Lowell, Massachusetts, United States
serp_jobs.job_card.full_time
A company is looking for a Behavioral Health Utilization Management Clinical Coordinator.Key Responsibilities Process Behavioral Health and Substance Use Disorder authorizations within designated...serp_jobs.internal_linking.show_more
serp_jobs.last_updated.last_updated_30 • serp_jobs.job_card.promoted
Overnight Care Advocate Coordinator

Overnight Care Advocate Coordinator

VirtualVocations • Lowell, Massachusetts, United States
serp_jobs.job_card.full_time
A company is looking for an Overnight Care Advocate Coordinator II.Key Responsibilities Provide exceptional member experiences through inbound / outbound calls in a fast-paced contact center Act a...serp_jobs.internal_linking.show_more
serp_jobs.last_updated.last_updated_variable_days • serp_jobs.job_card.promoted
Account Coordinator

Account Coordinator

VirtualVocations • Worcester, Massachusetts, United States
serp_jobs.job_card.full_time
A company is looking for a Core Accounts Coordinator to support its commercial Account Management team in the Vision division. Key Responsibilities Provide administrative and operational support t...serp_jobs.internal_linking.show_more
serp_jobs.last_updated.last_updated_30 • serp_jobs.job_card.promoted
Engagement Coordinator Full Time

Engagement Coordinator Full Time

HomeGoods • Leominster, Massachusetts, United States of America
serp_jobs.job_card.full_time
At TJX Companies, every day brings new opportunities for growth, exploration, and achievement.You’ll be part of our vibrant team that embraces diversity, fosters collaboration, and prioritizes your...serp_jobs.internal_linking.show_more
serp_jobs.last_updated.last_updated_variable_days • serp_jobs.job_card.promoted
Credentialing Coordinator

Credentialing Coordinator

VirtualVocations • Lowell, Massachusetts, United States
serp_jobs.job_card.full_time
A company is looking for a Credential Coordinator.Key Responsibilities Responsible for credentialing all Physicians and Allied Health Professionals Processes credentialing and re-credentialing a...serp_jobs.internal_linking.show_more
serp_jobs.last_updated.last_updated_30 • serp_jobs.job_card.promoted
Member Engagement Coordinator

Member Engagement Coordinator

VirtualVocations • Worcester, Massachusetts, United States
serp_jobs.job_card.full_time
A company is looking for a Member Engagement Coordinator (scheduler).Key Responsibilities Conduct member outreach via telephone, text, and email to engage patients for scheduling and confirming a...serp_jobs.internal_linking.show_more
serp_jobs.last_updated.last_updated_30 • serp_jobs.job_card.promoted
Regional Care Coordinator

Regional Care Coordinator

VirtualVocations • Worcester, Massachusetts, United States
serp_jobs.job_card.full_time
A company is looking for a Regional Care Coordinator to manage member experiences related to transportation services.Key Responsibilities Act as a liaison between health plan clients, members, an...serp_jobs.internal_linking.show_more
serp_jobs.last_updated.last_updated_30 • serp_jobs.job_card.promoted
Staffing Operations and Records Coordinator

Staffing Operations and Records Coordinator

Franklin Pierce University • Rindge, NH, US
serp_jobs.job_card.full_time
Summary of Position & Program / department .The Staffing Operations and Records Coordinator performs a wide variety of administrative tasks related to the day-to-day coordination of the recr...serp_jobs.internal_linking.show_more
serp_jobs.last_updated.last_updated_variable_days • serp_jobs.job_card.promoted
Travel Echo Tech - $2470 / Week

Travel Echo Tech - $2470 / Week

Premier Medical Staffing Services, LLC • Gardner, MA, US
serp_jobs.job_card.full_time
Premier Medical Staffing Services, LLC is seeking an experienced Echo Tech for an exciting Travel Allied job in Gardner, MA. Shift : 5x8 hr days Start Date : ASAP Duration : 13 weeks Pay : $2470 / Week....serp_jobs.internal_linking.show_more
serp_jobs.last_updated.last_updated_variable_days • serp_jobs.job_card.promoted
Community Life Service Coordinator

Community Life Service Coordinator

The Community Builders Inc. • Worcester, MA, United States
serp_jobs.job_card.permanent
About The Community Builders (TCB).Join a growing organization that is strengthening neighborhoods across the nation! The Community Builders, Inc. TCB) is one of America's leading nonprofit real est...serp_jobs.internal_linking.show_more
serp_jobs.last_updated.last_updated_30 • serp_jobs.job_card.promoted
Bilingual Intake Coordinator

Bilingual Intake Coordinator

VirtualVocations • Worcester, Massachusetts, United States
serp_jobs.job_card.full_time
A company is looking for a Bilingual Intake Coordinator to manage inbound requests and facilitate the authorization process. Key Responsibilities Document demographic information from telephonic, ...serp_jobs.internal_linking.show_more
serp_jobs.last_updated.last_updated_variable_days • serp_jobs.job_card.promoted
Engagement Coordinator

Engagement Coordinator

HomeGoods • Plainville, Massachusetts, United States of America
serp_jobs.job_card.full_time
At TJX Companies, every day brings new opportunities for growth, exploration, and achievement.You’ll be part of our vibrant team that embraces diversity, fosters collaboration, and prioritizes your...serp_jobs.internal_linking.show_more
serp_jobs.last_updated.last_updated_variable_days • serp_jobs.job_card.promoted
Intake Coordinator, Non-Clinical

Intake Coordinator, Non-Clinical

VirtualVocations • Lowell, Massachusetts, United States
serp_jobs.job_card.full_time
A company is looking for an Intake Coordinator, Non-Clinical PRN.Key Responsibilities Timely entry of home health referrals and communication with care center and business development staff Main...serp_jobs.internal_linking.show_more
serp_jobs.last_updated.last_updated_variable_days • serp_jobs.job_card.promoted
Provider Enrollment Coordinator II

Provider Enrollment Coordinator II

VirtualVocations • Worcester, Massachusetts, United States
serp_jobs.job_card.full_time
A company is looking for a Provider Enrollment Coordinator II, requiring credentialing experience.Key Responsibilities Ensure credentialing activities comply with URAC, NCQA, state, and federal r...serp_jobs.internal_linking.show_more
serp_jobs.last_updated.last_updated_variable_days • serp_jobs.job_card.promoted
Provider Enrollment Coordinator

Provider Enrollment Coordinator

VirtualVocations • Worcester, Massachusetts, United States
serp_jobs.job_card.full_time
A company is looking for a Provider Enrollment Coordinator who will manage credentialing processes for healthcare providers. Key Responsibilities Complete credentialing requests for Medicare and p...serp_jobs.internal_linking.show_more
serp_jobs.last_updated.last_updated_30 • serp_jobs.job_card.promoted
Bilingual Sleep Services Coordinator

Bilingual Sleep Services Coordinator

VirtualVocations • Worcester, Massachusetts, United States
serp_jobs.job_card.full_time
A company is looking for a Bilingual Sleep Services Care Coordinator.Key Responsibilities Answer calls from referral sources and secure referral orders in a call center environment Coordinate th...serp_jobs.internal_linking.show_more
serp_jobs.last_updated.last_updated_variable_days • serp_jobs.job_card.promoted