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Fallon Health Network Development and Mgmt. Contract Coordinator- growing Healthcare Org! Great Benefits -FT -2 days in the office in Worcester, Massachusetts

Overview

About Fallon Health:

Fallon Health is a mission-driven not-for-profit health care services organization based in Worcester, Massachusetts. For 45 years we have been improving health and inspiring hope in the communities we serve. Committed to caring for those who need us most, we pride ourselves on providing equitable access to coordinated, integrated care for our members with a special focus on those who qualify for Medicare and Medicaid. We also serve as a provider of care through our Program of All-Inclusive Care for the Elderly (PACE). Dedicated to delivering high quality health care, we are continually rated among the nation’s top health plans for member experience and service and clinical quality.

Brief Summary of Purpose:

This role will support the NDM contracting process with hospitals, physicians, and ancillary providers. This includes working with provider contract management software to assist in the timely implementation of contracts and improving the throughput of the contract implementation process. Interactions with non-contracted providers requesting a contract will be required, as well as working with Contract Managers and NDM Management in support of strategic initiatives.

Responsibilities

Job Responsibilities:

  • Assists in maintaining and managing Network Provider Contract Database (EVIPS) for Hospitals, Provider Groups and Ancillary providers including Individual Provider Agreements

  • Assists in ensuring accuracy with contract terms, provider rates, effective dates & other EVIPS contract entry requirements

  • Process Provider Letter of Interests by either issuing Network-Closed letters to providers or pulling appropriate documentation to assist assigned Contract Manager in issuing Provider Agreements

  • Process Individual Provider Agreements by collecting on-boarding information (e.g. W-9, Confidentiality Agreements & Provider Rosters)

  • Process Single Case Agreements and enter claim pricing in QNXT system

  • Assist with and support NDM’s Contracting Network-Build or other initiatives as needed by for example, preparing Health Service Agreements/Amendments and managing EVIPs entry workflow

  • Collaborate with intra and interdepartmental areas including NDM Operations, Credentialing Department, Provider Configuration and Provider Data Services, as needed

  • Ability to complete necessary tasks for NDM associated with and required to move projects to timely and successful completion

  • Supports NDM dashboard effort by tracking outcomes/success metrics and ensures accurate and timely reporting of key metrics

  • Actively pursues continued development / enhancement of skill set

  • Performs other duties as assigned

Qualifications

Education:

Bachelor’s Degree preferred.

License/Certifications:

N/A

Experience:

  • Requires experience working with cross-functional teams and competing priorities

  • Proficient in Microsoft Windows based office applications to include Excel, Word, PowerPoint, and SharePoint

  • Experience with eVIPS software and QNXT Trizetto platform desirable

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.

#P02

Location US-MA-Worcester

Posted Date 2 days ago (6/11/2024 10:29 AM)

Job ID 7614

# Positions 1

Category Network Development

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