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Fallon Health · 2 months ago

Member Intake Admin - Worcester Office based - $22/hr

US-MA-Worcester

Full-time

Hybrid

New Grad, Entry Level

$21/hr - $22/hr

Fallon Health is a company dedicated to providing high-quality healthcare services and is seeking a Member Appeals and Grievance Intake Administrator. This role is responsible for administering the appeals and grievance process, ensuring compliance with regulatory standards, and providing administrative support to the department.

FitnessHealth CareMedical

H1B Sponsor Likely

Responsibilities

Administer FH Standard and Expedited Appeals Processes as outlined in Member Handbook/Evidence of Coverage for all products, and in compliance with applicable NCQA standards and other state or federal regulatory requirements. Strict adherence to department turn-around time standards established in accordance with regulatory standards is required

Act as the initial investigator and contact person for member grievances and appeals, which includes, sending the appropriate acknowledgement of the grievance/appeal, educating the member and/or member representative about the grievance/appeal, gathering all pertinent and relevant information from the member regarding the grievance/appeal

Print, mail, and triage letters at the FH corporate office located at 10 Chestnut Street, Worcester, MA

Identifying the need for Personal Representative Authorization form, Medical Record Release Authorization form, or Provider Payment Waiver form and requests such documentation as necessary

Assigning case files to the department staff for case management

Managing incoming faxes and member specific data, routing to the appropriate staff member

Producing, maintaining, and distributing reports/calendars utilized by the team to assist in workload planning

Processes department incoming/outgoing mail per established workflows in a timely and accurate manner

Providing administrative/clerical support to the department which may include acquisition of medical records from providers

Retrieving messages from email and voice mailbox, routing to the appropriate staff member

Photocopy and compilation of appeal case file when necessary

Completion of request for additional information from external review agency

Responsible for additional clerical/administrative responsibilities at the discretion of the Director or Manager

Providing administrative assistance in support of the Board of Hearings (BOH) process, including preparation of hearing packets, reviewing of materials, as well as tracking and monitoring hearing decisions

Ensure that all grievances/appeals are processed in adherence to state and federal regulations (i.e., CMS, MassHealth, OPP), contractual obligations, NCQA guidelines and FH policy

Qualification

Administrative supportGrievance handlingHealthcare knowledgeCommunication skillsOrganizational skills

Required

Must be able to type 25 WPM

College Degree (B.S. or B.A.) or equivalent

Reliable transportation required

2 years college education (or knowledge of healthcare field equal to 2 years college preparation)

Company

Fallon Health

Founded in 1977, Fallon Health is a community-focused not-for-profit health care services organization based in Worcester, Massachusetts.

Founded in 1977

Worcester, Massachusetts, USA

1001-5000 employees

http://www.fchp.org

H1B Sponsorship

Fallon Health has a track record of offering H1B sponsorships. Please note that this does not guarantee sponsorship for this specific role. Below presents additional info for your reference. (Data Powered by US Department of Labor)

Distribution of Different Job Fields Receiving Sponsorship

Represents job field similar to this job

Trends of Total Sponsorships

2025 (8)

2024 (8)

2023 (5)

2022 (9)

2021 (7)

2020 (5)