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Fallon Health · 2 months ago

Eligibility & Revenue Operations Representative

US-MA-Worcester

Full-time

Onsite

Mid Level

$25/hr - $25/hr

4+ years exp

Fallon Health is a company dedicated to providing high-quality, coordinated care to its members. The Eligibility and Revenue Operations Representative plays a crucial role in maintaining accurate enrollment and billing information while ensuring compliance with regulations and collaborating with various departments to enhance service quality.

FitnessHealth CareMedical

Responsibilities

Works proactively to ensure the enrollment and billing records are kept current and accurate. Ensures goals and turnaround standards are being met or exceeded based on corporate and departmental metrics

Responsible for maintaining up to date primary care physician assignments in core system accurately and timely. This is to be completed through review of data integrity reports, and working closely with Provider Partners, Provider Relations, Contracting and Account and Provider Configuration

Maintains professional etiquette and positively represents Fallon Health when meeting in-person with customers for eligibility and premium related inquiries

Enters and maintains data in the E&B tracker in a timely and accurate fashion to to be utilized with the required reporting from CMS and EOHHS

Assists with core system upgrade testing

Assists in creating/maintaining desk top procedures and P&P’s

Assists Management team on audit responses and/or site visits

Participates in departmental and company-wide process improvement projects, training, upgrade testing and team meetings as assigned

Performs other duties as they are assigned to meet department performance goals and to respond to changing priorities including administrative related tasks

Works department returned mail

Quality control of enrollment and billing processes for accuracy and compliance to established policies and procedures

Responsible for maintaining up to date productivity records on a daily and monthly basis for corporate and departmental dashboards

Ensure adherence to documented payment plans

Qualification

Analytical skillsHealthcare experienceProblem-solving skillsMS ExcelMS WordMS AccessVerbal communicationWritten communicationOrganizational skillsTime managementTeam collaboration