Fallon Health Billing Operations Supervisor - Growing Health Care Org in Worcester, Massachusetts


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 the only health plan in Massachusetts to have been awarded "Excellent" Accreditation by the National Committee for Quality Assurance for its HMO, Medicare Advantage and Medicaid products. For more information, visit.


  • Supervise the business unit

  • Monitor the volume of work (daily, weekly) and current assignments. Schedule team members and adjust staff assignments to meet business needs.

  • Ensure team has appropriate resources and highlight areas of need to manager for resolution, via ongoing review of capacity plans with manager.

  • Regularly report on the productivity and effectiveness of the operation in comparison to established performance metrics. Perform root cause analysis for issues and determine the need for training or process changes. Collaborate with Data Integrity team. Recommend changes to the manager.

  • Implement approved changes to the existing business process to meet business requirements.

  • Monitor the work environment and the business operation. Raise concerns to the manager that may affect the morale and/or operational effectiveness of the group. Participate in implementing solutions as appropriate.

  • Serve as a subject matter resource

  • Acts as a senior resource person/subject matter expert for team members in all areas of the work, including but not limited to: application of appropriate policy and procedures, etc.

  • Assists the team in resolving routine operational issues as they arise. Serves as first level escalation with internal and external customers as necessary to resolve issues.

  • Assists with complex issues that fall within existing policy and procedures. Collaborates with manager in matters involving policy interpretation, exceptions to existing policy and procedure, etc.

  • Develop, edit, and promote use of established practices and procedures.

  • Promotes the use of accepted best practices and innovative strategies.

  • Collaborates with external departments on shared processes and process improvement, as well as on project teams.

  • Oversees relationship with external vendors.

  • Supervises and develops team

  • Participate in the orientation of new staff.

  • Train and mentor staff on the application of policy and procedures, documentation requirements, best practices, escalation requirements, use of supporting systems/applications, time management skills, etc.

  • Monitor work of individual staff for efficiency, effectiveness and quality. Provide ongoing constructive feedback and guidance to staff.

  • Works with manager to:

  1. Define roles and accountabilities for staff within the group, working with manager to ensure they support the broader process/operation.

  2. Hire for, develop and recognize the experience and knowledge/skills/abilities required for a successful team.

  3. Define performance expectations and goals for staff.

  • Evaluate staff on achievement of goals and deliverables and assessment of competencies. Help staff progress in their careers to the benefit of the department and broader organization. Manage the resolution of performance issues in consultation with the manager and Human Resources as appropriate.

  • Maintain effective channels of communication

  • Establish and maintain an open communication channel with staff.

  • Monitor effectiveness of communication with other groups (internal and external). Collaborates with manager to implement changes as necessary to ensure an open, productive exchange of information.

  • Provides financial analysis of aging receivables, collection of debt and timely action on uncollected debt.


Education: Degree strongly preferred.

Experience:minimum 3 years in collections; 5 years billing or accounting.

Supervisory experience strongly preferred.

Job ID 4869

# Positions 1

Location US-MA-Worcester

Posted Date 7/17/2017

Category Enrollment & Billing