Healthcare Provider Data Reviewer -Hybrid 3 days in office
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About The Position
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. Under the general supervision of the Manager of Configuration Audit and Directories, staff will perform an audit sampling of provider data within the symplr Payer application. Completes a score form in a Microsoft Access tool, prepares audit summaries, and sign off forms for staff and managers. Identifies trends in errors and recommends improved processes and/or training needs. Meets with Provider Specialist staff monthly to review error trends and collaborate solutions for issues related to provider data.
