UM Service Coordinator

Fallon Health - Worcester, MA

Full-time - Entry Level

Remote - Worcester, MA

Hospitals

About the position

The UM Service Coordinator is a telephonic role focused on managing prior authorizations for members by communicating with provider offices. This 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 involves handling incoming calls, processing authorization requests, and ensuring compliance with regulatory standards while providing excellent customer service.

Responsibilities

• Accept authorization service requests and notifications for members, screening for eligibility and authorization history.
• Initiate entry of requests into the core system (QNXT/TruCare) and update authorization information as needed.
• Handle a high volume of daily authorization entries and prepare records for filing according to company policy.
• Assist with departmental auto fax processes and generate notifications to members and facilities as per established protocols.
• Communicate with facilities/agencies/providers to collect data regarding care episodes and provide policy information.
• Manage inbound calls from providers and members, ensuring excellent customer service and addressing inquiries regarding authorizations.

Requirements

• Associate's degree preferred, with some advanced education highly preferred.
• Two or more years of office experience, preferably in a managed healthcare environment.
• Knowledge of medical terminology is required.
• Excellent telephone, typing, and computer skills, including proficiency in QNXT, TruCare, Excel, and Word.
• Strong organizational skills and the ability to maintain confidentiality.

Nice-to-haves

• Call center experience is helpful.
• Self-starter with the ability to identify tasks and request additional work when needed.
• Excellent listening and oral communication skills.

Benefits

• Work from home options after training period.
• Flexible work hours from Monday to Friday, 8 am to 5 pm.