Fallon Health · 14 hours ago
Eligibility and Revenue Financial Support
US-MA-Worcester, MA
Full-time
Onsite
Senior Level
$27/hr - $27/hr
5+ years expFallon Health is a company that prioritizes its members by providing high-quality, coordinated care. The Eligibility and Revenue Financial Support role involves maintaining accurate premium billing information and ensuring compliance with regulations while collaborating with various departments to enhance workflows and service quality.
FitnessHealth CareMedical
Responsibilities
Maintains receivable balances & Learning/Development
Responsible for production of all standard Daily and Month End reporting utilized by the Financial Senior Analyst; including but not limited to Accounts Receivable Summary, Aged Trial Balance, Credit, and balance forward reporting
Research accounts for refunds and adjustments, verifying for accuracy and compliance to established policies and procedures
Process, on a daily basis, ACH, CC, wire, returns, and payment batches in core system
Log payments received in-house from customers and deliver to Finance for deposit
Coordinates the accurate and timely production of all Premium Bill runs with outside Vendor, Cathedral, and Invoice Cloud
Reviews accounts for refunds and adjustments, verifying for accuracy and compliance with established policies and procedures
Posts 820 payment files received from State and Federal entities to members accounts
Processing of daily Lockbox and Invoice Cloud payment file
Prepare payment breakdown sheets to be sent to Finance for accurate recording of cash received
Ensure accuracy of premium payments posted on customers’ subsidiary accounts
Work with termed accounts on outstanding balances prior to sending them to collection agency
Work with the collection agency regarding delinquent accounts
Enters and maintains premium rates received from the State or CMS in the core system
Works proactively to ensure premium billing records are kept current and are accurate
Work with Financial Senior Analyst in the validation of the wire log and premium wash account
Assist in testing updates made to financial reporting from the core system
Works with management team for creation of updated workflows related to accounts receivable processing
Works with QA on the creation/maintenance of desk top procedures and P & P’s
Ensure newly created financial metrics are met
Assists Management team on audit responses and/or site visits
Participate in departmental and company-wide process improvement projects, training, testing and team meetings as assigned
Works department returned mail
Provides detailed analyses and explanations of all transactions to Enrollment and Billing Director/Manager and COO as requested
Performs other duties as they are assigned to meet department performance goals and to respond to changing priorities including administrative related tasks
Additional duties may be assigned or requested by the Director or Manager
Qualification
Required
High School diploma required
5 plus years' experience in an office environment, preferably in health care and/or managed care system
Financial background; Premium Billing experience a plus
Strong analytical and problem-solving skills
Flexibility in a fast-paced environment
Excellent Organizational skills/time management
Strong focus on quality & performance results
Systems knowledge including but not limited to MS Excel, MS Word
Ability to effectively communicate, both written and verbal
Builds Relationships/contributes to team performance
Respond to all audit requests timely
Adhere to all DOI, State, and Federal guidelines
Preferred
Bachelor's Degree preferred or equivalent experience
Company
Fallon Health
Founded in 1977, Fallon Health is a community-focused not-for-profit health care services organization based in Worcester, Massachusetts.
1001-5000 employees
Funding
Current Stage
Late StageLeadership Team
Dorothy Vandette
Manager, CEO Office
Todd Bailey
Senior Vice President, Chief Financial Officer
Recent News
2026-01-09
2025-08-07
2025-06-07
Company data provided by crunchbase