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Fallon Health · 1 day ago

Provider Specialist

US-MA-Worcester

Full-time

Onsite

Entry, Mid Level

2+ years exp

Fallon Health is a company dedicated to providing high-quality, coordinated care to its members. The Provider Specialist role involves responding to inquiries from healthcare providers, resolving operational concerns, and collaborating with internal departments to improve processes. This position also includes updating provider information and maintaining documentation within the company's systems.

FitnessHealth CareMedical

H1B Sponsor Likely

Responsibilities

Receive daily calls and email correspondence from assigned physicians, hospitals, and ancillary providers requesting information and services

Act as primary point of contact with assigned providers by promoting a one-stop customer service for escalated provider service issues. Escalations come from internal departments and external provider contacts

Utilize appropriate internal resources in order to analyze and resolve issues

Monitor status of QNXT cases thru to resolution status. Maintain detailed documentation within QNXT cases. Conduct proactive follow-up activities with provider and/or Fallon Health staff

Validate data received by providers and update demographic and practice changes at the request of the assigned provider

Adhere to departmental, corporate standards and policy and procedure (i.e., Fallon Health Service Level agreements) issue resolution timeframes, PUNKS, QNXT case inventory/assignments, etc.)

Assist and support the Provider Relations Representative on Provider enrollment initiatives

Escalate critical issues and conflicts to Manager, Provider Data or Sr. Director, Benefit and Provider Configuration as appropriate

Maintains assignments related to assigned territory, [i.e., internal Joint Operations Committee meetings, provider contract knowledge, PCP reports (changes, additions, deletions)], as appropriate

Participate in external and internal provider meetings for assigned provider territory on a schedule or dependent upon urgency identified by Manager

Manage all Provider Adds/Updates in the eVIPS application

Process any Group/Facility needs as identified by the Contracting Team in the eVIPS application

Qualification

Customer service experienceQNXT/eVips proficiencyMicrosoft Office proficiencyMedical terminology knowledgeClear communication skillsOrganizational skills

Required

Bachelor's degree or equivalent combination of training and experience

2 years' experience in a customer service role for a healthcare services organization

Proficiency with desktop computer applications, Microsoft Office package, mainframe knowledge (QNXT/eVips)

Knowledge of medical terminology/claims payment, ICD and CPT coding familiarity

Exemplary customer relations expertise

Clear concise written and verbal communication skills

Ability to manage, organize, document and prioritize multiple tasks simultaneously

Company

Fallon Health

Founded in 1977, Fallon Health is a community-focused not-for-profit health care services organization based in Worcester, Massachusetts.

Founded in 1977

Worcester, Massachusetts, USA

1001-5000 employees

http://www.fchp.org

H1B Sponsorship

Fallon Health has a track record of offering H1B sponsorships. Please note that this does not guarantee sponsorship for this specific role. Below presents additional info for your reference. (Data Powered by US Department of Labor)

Distribution of Different Job Fields Receiving Sponsorship

Represents job field similar to this job

Trends of Total Sponsorships

2025 (8)

2024 (8)

2023 (5)

2022 (9)

2021 (7)

2020 (5)