Job details

Medicare plan documents coordinator- part time 33 hours Growing Healthcare Organization- Flexible work arrangement

Overview:

About Fallon Health:
Fallon Health is a mission-driven not-for-profit health care services organization based in Worcester, Massachusetts. For 45 years we have been improving health and inspiring hope in the communities we serve. Committed to caring for those who need us most, we pride ourselves on providing equitable access to coordinated, integrated care for our members with a special focus on those who qualify for Medicare and Medicaid. We also serve as a provider of care through our Program of All-Inclusive Care for the Elderly (PACE). Dedicated to delivering high quality health care, we are continually rated among the nation’s top health plans for member experience and service and clinical quality.

Brief Summary of Purpose:

This position manages the distribution and tracking of Medicare Advantage and PACE regulatory and sub-regulatory guidance from the Centers for Medicare & Medicaid Services (CMS) via HPMS memos to ensure timeliness and applicable deadlines are met; this includes items such as the annual rate notices, plan reminders of required actions and deadlines, and manual revisions. Submits marketing materials to regulatory agencies as delegated. Support Medicare Programs by assisting or leading special projects such as CMS audit documentation collection and submission, reviewing Annual Notice of Change (ANOC) documents for accuracy and completeness, and this may include coordinating with departments throughout Fallon and with contracted vendors. Manages all aspects of developing and submitting all Medicare Advantage and Senior Care Options Evidence of Coverage (EOC), Schedule of Benefits (SBs) and Low-Income Subsidy (LIS) Rider documents. Leads the oversight of HPMS’ Complaints Tracking Module (CTM) for appropriate and timely responses with the CMS-defined timelines.

Responsibilities:

Job Responsibilities:

Distribute and track all Medicare Advantage and PACE regulatory and sub-regulatory guidance received from CMS via HPMS, including summary analysis, distribution to business owners, impact on operations, and any associated deadlines. Maintain current list of subject matter experts, by topic, for distribution of memos. Follow up with Medicare Programs’ subject matter experts as needed to help ensure implementation and deadlines are met.
Support Medicare Programs by assisting or leading special projects such as CMS audit documentation collection and submission, review of Annual Notice of Changes (ANOC). This work often includes coordinating with departments throughout Fallon and with contracted vendors.
Lead the oversight of HPMS’ Complaints Tracking Module requests received for all Medicare Advantage and PACE contracts. This includes the review, revision and/or approval of the drafted Customer Service responses in partnership with other Medicare Programs staff.
Manage the development and submission (when applicable) of all Medicare Advantage EOCs, SBs for EGWPs, and LIS Riders to ensure documents are completed in a timely and accurate to comply with all regulatory requirements. CMS imposes strict deadlines on the production and mailing of these documents. The creation of these documents involves very detailed, complex and time-consuming formatting. This would also include developing plan documents to support new Medicare plan types Fallon may contract with CMS to offer.
- For plan documents: identify changes in the CMS models compared to previous year documents. Work with departments to develop required language to complete the documents to ensure all documents are accurate and complete by the required deadlines.
Submit marketing materials as delegated, such as File and Use materials.
Maintain knowledge and understanding of the Medicare Communications and Marketing Guidelines (CFR 42, Part 422, Subpart V, Medicare Advantage Communication Requirements), SCO marketing requirements, and PACE Chapter 3 Marketing Guidelines, as well as other MMCM and Medicare Prescription Drug Benefit Manual (MPDBM) chapters that impact materials.
Maintain basic knowledge of MMCM Chapters 2 and 13, MPDBM Chapters 4, 13, and 18 to assist with the oversight of the CTM and material reviews.
Support the completion of the required yearly Plan Benefit Package (PBP) as needed, tasks may include but are not limited to the entry of benefits, quality checks of data entered and screenshots.
Responsible for assisting in the annual review/revision Medicare Programs’ policies and procedures. Maintains applicable policies and procedures such as EOC development, CTM oversight, and HPMS memo distribution, to ensure they remain current as part of the yearly review/revision process or more frequently as needed.
Serve as policy and procedure librarian for assigned business areas within the company. This entails sending out monthly reminders in advance of deadlines, answering business area questions as they arise and ensuring updated documents are posted to iFallon timely.
Participate in CMS user group calls.
Report monthly data associated to HPMS memos and CTMs in the Medicare Dashboard files and submit the summary of results which may include proposed corrective actions as needed.
Assist with the oversight of Part C & D reporting quality review of entered data and the yearly Part C & D Data Validation process with Fallon’s external vendor as needed.

Qualifications:

Education:

Bachelor’s degree in business, health care or related area or equivalent job experience

License/Certifications:

N/A

Experience:

3-5 years managed care or relevant industry experience
2 years Medicare Advantage experience preferred

Fallon Health provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.

Fallon Health Vaccination Requirements:

To protect the health and safety of our workforce, members and communities we serve, Fallon Health now requires all employees to disclose COVID-19 vaccination status. As of 2/1/2022 all roles not designated as “Remote” require full COVID-19 vaccination and Fallon Health will obtain the necessary information from candidates prior to employment to ensure compliance. Failure to meet the vaccination requirement may result in rescission of an employment offer or termination of employment.

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Fallon Health Glassdoor Company Review

3.7