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Provider Triage / Intake Specialist

Company: Fallon Health
Location: Worcester
Posted on: October 14, 2019

Job Description:


* Responsible for processing all incoming provider appeal mail, as well as forwarding all initial claim submissions, claim adjustments, non-contracted provider appeals and other miscellaneous mail to appropriate departments.

* Tracking all provider appeals as well as determining type of appeal.

* Initial review of all appeals (including but not limited to determining if appeal was received within submission timeframes, if claims has already been paid, if member appeal, etc.)

* Processing of reports which produce all correspondence to providers related to appeal determinations and untimely requests, as well as sending those correspondence to providers.

* Filing of individual provider appeal files in accordance with department standards.

* Maintain provider appeal database and analyze data to assist Provider Appeal Coordinator in production of monthly reports forwarded to Management.

* Other duties as assigned.


Education: High school diploma

Experience: Minimum 2 years experience in the operational side of a managed care organization required.

Additional Performance Requirements:

Must be proficient with personal computer applications, including Microsoft Office package and PowerPoint.
Knowledge of QNXT preferred.
Excellent organizational and communication skills.
Strong interpersonal and customer service skills.
Must be detail-oriented.
Knowledge of claims protocol, referral and authorization process, benefit coverage and provider contracts preferred.

Fallon Health is an equal opportunity employer. It is very important for us to maintain a consistant hiring process for every candidate. In addition, we are also a government contractor with requirements to report on our Affirmative Action planning. To that end, we require everyone to apply online.

If you do not have access to a computer or need assistance completing the application process, please contact Human Resources at 1-508-368-9893 (TRS 711).

Keywords: Fallon Health, Worcester , Provider Triage / Intake Specialist, Other , Worcester, Massachusetts

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