UM Service Coordinator

Fallon Health - Worcester, MA

Full-time

Remote - Worcester, MA

Hospitals

About the position

The UM Service Coordinator is a telephone-based role focused on managing prior authorizations for members by communicating with provider offices. The position requires initial training in the Worcester office for up to six months, after which the employee can work from home three days a week. The role operates Monday to Friday from 8 AM to 5 PM, emphasizing member care and support in a collaborative environment.

Responsibilities

• Accept authorization service requests and notifications for FCHP members, screening for eligibility and authorization history.
• Initiate entry of requests into the core system (QNXT/TruCare) and case management application as applicable.
• Update authorization information in QNXT based on determinations made by Authorization Coordinators and Nurse Reviewers.
• Handle a high volume of daily authorization entries into the core system, with targets communicated regularly by management.
• Prepare completed authorization records for filing in accordance with company policy.
• Assist with departmental auto fax processes and generate notifications to members and facilities as per established protocols.
• Interface with other departments to verify information relevant to pre-authorization requests.
• Manage applicable queues in both the core system and case management application.
• Communicate with facilities/agencies/providers to collect data regarding episodes of care and provide policy information.
• Provide first response to inbound calls, ensuring excellent customer service and managing the ACD hunt line.

Requirements

• Associates Degree preferred, with advanced education highly preferred.
• Two or more years of office experience, preferably in a managed healthcare environment.
• Call center experience is helpful; knowledge of medical terminology is required.
• Computer literacy and data entry experience are required.
• Excellent telephone, typing, and computer skills.
• Strong organizational skills and excellent listening/oral communication skills.
• Ability to maintain confidentiality of patient and proprietary business information.

Nice-to-haves

• Experience with QNXT and TruCare systems.
• Familiarity with Excel and Word.

Benefits

• Flexible work schedule after training (work from home three days a week).
• Opportunities for professional development and training.