Physician Liaison – Elder Services Clinical Setting

Fallon Community Health Plan
Published
February 12, 2020
Location
Worcester, MA
Job Type
 

Description

Physician Liaison - Elder Services Clinical Setting

US-MA-Worcester

Job ID: 5892
Type: Full Time
# of Openings: 1
Category: Credentialing
Fallon Health - Corp HQ

Overview

SUMMIT ELDERCARE (www.summiteldercare.org)
Fallon Health's - Summit Elder Care program one of the largest PACE programs (Program of All-Inclusive Care for the Elderly) in the country and the very first PACE program in the nation to be associated with a Health Plan. As a Physician in this field, this is a great alternative for Primary Care and Internal Medicine doctors who are tired of being tied to high volume and RVU's. We have a quality over quantity approach and patient load is under 10 on most days.
Summit ElderCare currently already serves residents of Hampden County, Worcester County, and the communities of Easthampton, Granby, Hudson, Marlborough, Southampton and South Hadley. We help give elderly adults and their caregivers an innovative choice in health care as a welcome alternative to nursing home care. Participants in Summit ElderCare have access to most medical services through a Summit ElderCare site while they keep living in their own homes and communities. Summit ElderCare provides individualized quality care by a team of geriatric care professionals who work together with participants and caregivers to address each individual's specific needs. This Interdisciplinary team of professionals is an essential component of the Summit ElderCare PACE program and uses a collaborative approach to care FALLON HEALTH (www.fchp.org)

About Fallon Health
Founded in 1977, Fallon Health is a leading health care services organization that supports the diverse and changing needs of those we serve. In addition to offering innovative health insurance solutions and a variety of Medicaid and Medicare products, we excel in creating unique health care programs and services that provide coordinated, integrated care for seniors and individuals with complex health needs. Fallon has consistently ranked among the nation's top health plans, and is accredited by the National Committee for Quality Assurance for its HMO, Medicare Advantage and Medicaid products. For more information, visit fallonhealth.org.
Responsible for managing, improving, maintaining and coordinating operational relationships with Providers. Ensures all Summit ElderCare Providers are effectively on-boarded, informed, supported and educated regarding PACE operations. Represents Fallon Health's Summit ElderCare PACE program with high level of professionalism both internally and externally.

Under minimal supervision, independently works to complete multiple high-level operational and administrative projects and provides ongoing support of the VP/Medical Director, Associate Medical Director(s), and all Summit ElderCare Providers; this may include but is not limited to provider onboard ing, scheduling, credentialing, reporting and billing.

Responsibilities

  • Following a comprehensive Provider onboarding schedule, ensures each new provider is appropriately oriented to his/her new position/role as well as the PACE model of care prior to being assigned his/her own patient panel, and assigns all new providers a peer mentor to follow them throughout their first six months in the position.
  • Creates and submits Service tickets for Provider access to the Electronic Health Record and other relevant applications, registering all SE providers in contracted hospital EHR systems so that they may have real-time access to SE participant medical records.
  • Works with hospital staff to obtain provider medical records access for all contracted inpatient facilities.
  • Assists with completing onboarding and Credentialing Paperwork (HCAS, SNF credentialing applications, registration documents to gain access to inpatient medical records systems, etc.).
  • Coordinates with EHR trainer to ensure newly hired providers as well as existing providers are provided with appropriate level of instruction in electronic health record.
  • Works collaboratively with Service Delivery team to ensure appropriate number of licenses for the Electronic Health Record.


Ongoing Provider Support

  • Works closely with the SE Enrollment Coordinator RNs to ensure receipt of prospective enrollee medical records requested from Community Physician Practices for review by the IDT in determining eligibility for enrollment.
  • Works closely with the FH Privacy Officer to ensure appropriateness of all Medical Records Requests received either from SE participants/caregivers or external entities and works with site office staff to ensure timely processing of approved requests.
  • Receives and processes, in collaboration with the SE VP/Medical Director, all provider time off requests.
  • Coordinates time off requests for all SE providers in collaboration with the respective Site Directors and Clinical Managers to ensure appropriate clinical site coverage.
  • Assists SE Providers with Oracle expense reporting by submitting and tracking mileage and expense reimbursement requests on a monthly basis.
  • Processes CME registration and reimbursement requests and arranges related travel (hotel, air and ground transportation); tracks CME spend and reimbursements.
  • Reviews all charges and creates 837 file for non-statistical claims processing for all SE Providers; r eviews and processes EPM provider claims billing on a weekly basis.
  • Manages the Provider On-Call Schedule and ensures any necessary changes are made in a timely manner and communicated to the answering service.

Acts as the SE liaison to the after-hours answering service, reviewing and processing all answering service invoices for payment and generating

  • answering service reports as necessary to ensure compliance with CMS/PACE regulatory requirements.
  • Meets regularly with the Senior Directors, Regional Operations (both regions) to discuss Provider challenges and collaboratively develops plans to address these challenges.
  • Works with other FH departments to obtain SE Provider-specific productivity and utilization reports and distributes on a regular basis to each Provider.
  • Works with the SE sites to ensure that, on a monthly basis, Provider panels are validated and reconciled against QNXT reports for accurate provider assignments across the program.
  • Maintains Provider orientation and information files and updates as needed.
  • Maintains Provider contact list and shares with each site and others as appropriate on a regular basis.
  • Acts as point person for MA Medical Society regarding membership & payment.
  • Maintains and tracks vendor confidentiality agreements.
  • Distributes annual provider survey forms to selected providers and tracks responses for VP/Medical Director.
  • Maintains Personnel files for all SE Provider Staff & other VP/Medical Director direct reports.
  • Provides calendar management for VP/Medical Director and Associate Medical Director(s).


Monthly Provider Meetings

  • In collaboration with the VP/Medical Director, plans and coordinates monthly Provider Meetings; responsibilities include, but are not limited to, creating and distributing the agenda, attending meetings and recording and posting the minutes, ordering refreshments, setting up the video-conferencing equipment so Providers may participate in the meetings remotely, when needed.

Other

  • Completes all work in a timely manner as assigned by the SE VP/Medical Director and other SE senior leaders.

Completes other tasks, projects, and duties as assigned.

Qualifications

  • 3-5 years operational & administrative experience in a medical provider practice required with credentialing, provider scheduling, and medical records management; legal and/or HMO setting preferred
  • Substantial understanding of clinical practice operations and medical terminology
  • Clear understanding of the PACE model of care with PACE center experience highly desirable; must be able to quickly understand the scope and type of services that PACE provides.
  • Skilled in gathering data, research, preparing reports and presenting well thought out recommendations & justifications
  • Must be willing to travel to all Summit ElderCare PACE sites on a regular basis for Provider support and assistance; Reliable transportation required.
  • Flexibility in adjusting to changing conditions & various details of the position:
    • ability to multitask and prioritize competing demands
    • willingness and ability to adjust and respond urgently

skilled at working with a large and diverse group.
PI117952293

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