Summit Eldercare Service Coordinator

Fallon Health is a mission-driven organization that prioritizes its members, delivering equitable, high-quality coordinated care. Founded in 1977 in Worcester, Massachusetts, we 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), an alternative to nursing home care that helps people 55 and older continue living safely at home. We embrace diversity in all its forms and strive to be the leading provider of government-sponsored health insurance programs—including Medicare, Medicaid, and PACE—in the region.

About the role

Provides coordination, scheduling, and problem resolution for all approved home care services for Summit ElderCare participants. Documents all actions in a timely manner in an electronic medical record (EMR). Supports other program administration needs as assigned.

Responsibilities

• Coordinates and schedules home care services to implement the plan of care established by the interdisciplinary team (IDT).
• Works collaboratively with Home Care nurses and other staff, vendors, participants, and families to support Summit ElderCare’s mission, promote high-quality care and service, and foster positive internal and external customer relations.
• Communicates with home care agencies and other vendors to coordinate services, including initial orders, changes, cancellations, and resumption of services.
• Demonstrates professionalism and acts as an ambassador for Fallon Health and Summit ElderCare at all times.
• Emails or faxes open case needs to home care agencies as required.
• Effectively utilizes established systems and procedures to identify problem cases and alert management of the need for additional interventions.
• Follows up on all non-assigned cases as required until services are secured.
• Documents all vendor authorizations and service coordination efforts in the EMR and other identified systems as assigned.
• Documents all participant-related telephone calls in the EMR.
• Facilitates timely delivery of service authorizations to vendors.
• Maintains a positive working relationship with peers, vendors, and other staff.
• Maintains an accurate record of participants’ home care services in a designated format.
• Utilizes established systems to track data as assigned.
• Prepares reports as requested.
• Conducts periodic audits of claims paid to ensure services were authorized by the IDT and facilitates resolution of identified issues.
• Participates in the weekend on-call rotation.
• Performs photocopying, faxing, and other clerical duties as required.
• Performs other duties as assigned by the Operations Manager and other leadership staff.

Requirements

• High School diploma or equivalent preferred, or substantial work experience.
• Past home care coordination experience highly desirable.
• Previous customer service experience preferred.
• Excellent telephone and customer service skills.
• Strong relationship-building and organizational skills.
• Strong work ethic and basic computer/office skills, specifically with Microsoft Office.
• Ability to plan work and meet required deadlines.
• Ability to work in a fast-paced environment.
• Basic math skills.
• Ability to learn insurance terminology related to authorizations, claims, and payments.
• Ability to perform multiple tasks efficiently and accurately, and to proactively identify problems and resolve issues with minimal supervision.

Pay

The pay for this position is budgeted for $23.20 per hour. Final compensation will depend on the candidate’s experience, skills, and fit with the role’s responsibilities.