Eligibility & Revenue Operations Representative- Hybrid Schedule

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, Fallon Health delivers equitable, high-quality, coordinated care and is continually rated among the nation’s top health plans for member experience, service, and clinical quality. 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 (Program of All-Inclusive Care for the Elderly)—in the region.

About the role

Pre-requisites for success in this position include strong verbal and written communication skills, including demonstrated excellence in telephone communication skills, strong organizational skills, and computer skills. The Eligibility and Revenue Operations Representative performs all functions necessary to maintain accurate subsidiary accounts receivable and ensures accuracy of premium bills. They analyze and reconcile receivables balance for Commercial and Regulatory products to identify problems with payments and/or impose the delinquency process. They study contractual terms and conditions to ensure payments received meet contractual requirements.

This role handles confidential customer information and requires knowledge of plan policies, protocols, and procedures. The ability to work in a fast-paced environment with multi-disciplined staff is essential, along with strong multitasking abilities, accountability, and adaptability to changing job functions based on business needs. The position also involves enrollment and billing maintenance, adhering to daily, weekly, and monthly schedules, and administrative-related tasks.

Responsibilities

• Maintain accurate subsidiary accounts receivable and ensure accuracy of premium bills.
• Analyze and reconcile receivables balance for Commercial and Regulatory products to identify payment issues and impose the delinquency process as needed.
• Study contractual terms and conditions to ensure payments received meet requirements.
• Handle confidential customer information with discretion.
• Perform enrollment and billing maintenance, adhering to daily, weekly, and monthly schedules.
• Complete administrative-related tasks efficiently.
• Follow through on issue resolution consistently.
• Initiate self-development via available company and industry educational opportunities.

Requirements

• A verifiable high school diploma or GED is required (unless specified otherwise).
• Bachelor’s Degree preferred.
• 4+ years of experience in an office environment, preferably in health care and/or managed care systems.
• Prior experience working with Medicaid/Medicare is beneficial.
• Strong verbal and written communication skills, including telephone communication.
• Excellent organizational and computer skills.
• Ability to work in a fast-paced environment and multitask effectively.
• Accountability and adaptability to changing business needs.

Pay

The pay for this position is $25.00 per hour, reflecting 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.