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, we deliver equitable, high-quality coordinated care and are continually rated among the nation’s top health plans for member experience, service, and clinical quality.

Fallon Health’s Summit ElderCare® is a Program of All-Inclusive Care for the Elderly–PACE for short. PACE, an alternative to nursing home care, is a program that helps people 55 and older continue living safely at home. At Fallon Health, 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— in the region.

Brief summary of purpose:

Manages administrative functions related to running a PACE center. Responsible for hiring, training, supervision and retention of support/administrative staff. Conducts or oversees processing of claims, data collection and reports including those related to the Electronic Medical Record (EHR). Assures that all functions are completed in an accurate and timely manner. Maintains a positive, professional, collaborative relationship with staff and vendors.

Responsibilities

Primary Job Responsibilities:

• Manages all supervisory functions for site based support staff including hiring, training and disciplinary actions.
• Completes annual employee evaluations and competencies. Conducts monthly staff meetings.    
• Oversees intake and enrollment process for prospective enrollees.    
• Assures that all demographic and other non-clinical information is entered into the EHR and documents are scanned according to established procedures.   
• Functions as Transportation Coordinator, or oversees a designee, to assure safe and timely transport of all participants to/from the site, home and appointments.   
• Collects and enters all data related to HPMS reporting.  
• Manages the preparation of all claims and invoices. Maintains referrals.     
• Manages memorial donations and communicates to appropriate Fallon Health staff.     
• Maintains attendance logs and meeting minutes and certification logs as requested by Site Director.
• Assures that front-desk/reception area is always staffed while site is open.
• Manages and maintains appointment scheduling functions including assisting participants with scheduling outside appointments.
• Responsible for attending and taking minutes for various meetings.
• Other duties and special projects as assigned.

Qualifications

Education:

• Associates degree preferred or applicable work experience
• A verifiable high school diploma or GED is required for all positions at Fallon Health and its affiliates, unless specified otherwise.

License/Certifications:

Access to reliable transportation to perform work throughout the PACE center’s service area (30-mile radius) when needed. Willingness to occasionally assist other SE PACE centers either in person or remotely, as appropriate, when there is an opening or a gap in coverage.

Experience:

• 3 years supervisory experience.
• Experience in a health care or insurance setting preferred but not required.
• Excellent computer skills including familiarity with information retrieval, data collection and word processing
• Excellent verbal and written communication skills

Pay Range Disclosure:In accordance with the Massachusetts Wage Transparency Act, the pay for this position is $65,00 -$67,000 annually which reflects what we reasonably and in good faith expect to pay at the time of posting. Final compensation will depend on the candidate’s experience, skills, and fit with the role’s responsibilities.

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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