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Health Plan Liaison

4 months ago

Tampa, Florida, United States Physician Partners Full time

Our mission is Better Health. Our passion is helping others.

What's Your Why?


• Are you looking for a career opportunity that will help you grow personally and professionally?


• Do you have a passion for helping others achieve Better Health?


• Are you ready to join a growing team that shares your mission?

Why Join Our Team: At Better Health Group, it's our commitment, our passion, and our culture that sets us apart. Our Team Members make a difference each and every day They support our providers and payors, ensuring they have the necessary tools and resources to always deliver best-in-class healthcare experiences for our patients. We don't just talk the talk - we believe in it and live by it. Be part of a team that shares your passion and drive, and start living your purpose at Better Health Group.

Responsibilities

The Health Plan Liaison will directly support the Better Health Group Team. They will be expected to perform within the following scope, as well as other assigned duties and activities that aid and leverage our Team function. Responsibilities include and are not limited to:

Support Health Plan Joint Operations Committees

Coordinate with Health Plan representatives to schedule meetings on a monthly or quarterly basis

Solicit agenda items from all Better Health Group department leads

Create the meeting agenda and/or presentation and share it with attendees before the meeting

Agendas must be shared with all attendees at least 7 days before the meeting

Lead the meeting and introduce attendees if applicable

Must arrive at the meeting on time

Must introduce all Better Health Group attendees with the correct name and title

Create meeting action items and share them with attendees after the meeting

Action items should be shared with all attendees within 1 business day after the meeting

Follow up on action items discussed during the meeting

All communication before, during, and after each JOC meeting is clear, concise, and free of errors

Cultivate strong and positive relationships with Health Plan partners

Demonstrate ability to manage time and organize meetings effectively

Utilize Google Calendar effectively

Act as the point of contact to resolve PCP office-specific issues

Manage intake for PCP office-specific, health plan-related inquiries via the Google form submission process and update and maintain status columns until resolution

Demonstrate ability to research, investigate and actively resolve simple to complex issues; escalate as necessary to Manager and/or Director of Core Operations; provide guidance on available resources before forwarding the communication

Research each issue to determine if it can be resolved internally or whether Health Plan outreach is needed. If the issue can be resolved internally, educate the team members on the appropriate process

If Health Plan outreach is needed, email the applicable Health Plan Representative and follow up until resolution

Demonstrate discernment and respond within the same business day for urgent requests (inquire with the Manager / Director to define as needed) and within 2 business days for non-urgent requests

Team members should follow up with applicable parties on at least a weekly basis until the issue is resolved

Demonstrate knowledge of Health Plan specific policies, procedures, and resources

Maintain a great attitude and can build and foster positive relationships with PCP offices, Health Plan partners, and internal teams

Support Credentialing team with Provider Office Maintenance requests (Age Band, Cap Rate / Payment Methodology Changes, Credentialing, Office Demographic Changes, Panel Status Changes, Service Area Expansions, Terminations)

Check Google form submissions to ensure accuracy

Confirm that requests are received by the Credentialing Team and submitted to the Health Plans

Confirm that the Credentialing Team follows up until the changes are confirmed by the Health Plan

Update internal trackers and systems immediately to reflect changes

Terminations:

Communicate updates same day to internal teams affected by the termination of PCP

Follow up weekly until the Health Plan representative confirms the termination was processed and notification letters were sent to the patients

Confirm patients were transferred to the appropriate recipient PCP after the termination effective date has passed within 2 business days of the patient roster being updated

Create and update/maintain Health Plan Resources documents and quick reference guides

Create quick reference guides compiling information from various health plans into a single resource to be used by internal and external parties

Identify the need for new resources to be created based on requests received from internal teams

Once the need for a new quick reference guide is determined by Better Health Group management, the new document should be completed within by the due date specified by the Manager of Core Operations

Update each quick reference guide at least once per calendar year or as changes occur

Ensure documents are 100% accurate and free of grammatical and formatting errors

Disseminate materials to all applicable internal and external parties

Create Action / Project plans for onboarding new Health Plans / Markets

Create a list of targeted PCP offices to participate in the expansion

All action items are completed by the due dates set forth by the Health Plan and Manager of Core Operations

For Health Plan onboarding

Create an accurate contact list for distribution to the Better Health Group team

Introduce key Health Plan stakeholders to the Better Health Group team

Communicate updates and timelines to all internal department leads

Communication with internal teams and Health Plan partners is clear and concise throughout the expansion process

Obtain an onboarding orientation packet from the Health Plan to be distributed to the Provider Operations team

Obtain credentialing documents from the Health Plan

Work closely with Provider Operations to ensure PCP Offices are targeted and informed appropriately regarding Health Plan expansions

Ensure the accuracy of the PCP office target list and action plan throughout the expansion process

Follow up credentialing paperwork submissions weekly to ensure deadlines are met

Work closely with Health Plan representatives to complete all action items throughout the process

Communicate with the Health Plan representative at least weekly throughout the expansion process to confirm all action items are completed on time

Ensure health plan open task spreadsheets are complete and up to date with current statuses weekly by Tuesday of each week

Send open health plan task spreadsheets to the Health Plans weekly or at the frequency agreed upon with the specific health plan

Review the open task list during meetings with the health plans as applicable

Once responses are received from the health plan, update the status and take action as needed

Support the annual AEP process

Create panel status changes tracker and distribute to Provider Operations and VIPcare leadership teams to review and make changes; follow up until completed

Participate in the review of the Provider Directory to confirm accuracy before printing

Attend and participate in Core Operations team meetings, 1:1 meetings with the Manager of Core Operations, and interdepartmental market meetings as required

Other designated administrative, clerical, or operational tasks as assigned to leverage Better Health Group's goals

Key Attributes:

Has a contagious and positive work ethic, inspires others, and models the behaviors of our core values and guiding principles

An effective team player who contributes valuable ideas and feedback and can be counted on to meet commitments.

Can work within our Better Health environment by facing tasks and challenges with energy and passion.

Pursues activities with focus and drive, defines work in terms of success, and can be counted on to complete goals.

Demonstrated ability to handle data with confidentiality

Additional Education & Skills:

Bachelor's degree in Healthcare Administration or related field preferred

At least 3 years of experience in a healthcare-related environment

Proven ability to work with Google Suite software or equivalent (MS Excel and MS PowerPoint)

Ability to work independently with minimal supervision

Bilingual (English/Spanish) highly preferred but not required

Excellent organizational, time-management, and multi-tasking skills with strong attention to detail

Demonstrated resourcefulness, initiative, and results-oriented capabilities

Ability to work in a shifting and fast-paced environment

Must be able to work professionally with confidential information

Excellent written and verbal communication skills including telephone calls, emails, and like communication.

Ability to work cross-functionally with multiple teams

Ability to shift focus, multi-task, and prioritize in a rapidly changing environment.

STRONG reasoning and critical thinking are required.

MUST be results-oriented with a focus on quality execution and delivery.

Compensation & Benefits

We offer a compensation w/bonus and a comprehensive benefits package:

Medical, dental, vision, disability, and life

401k, with employer match

Paid time off

Paid holidays

Please note this job description is not designed to cover or contain a comprehensive listing of activities, duties, or responsibilities that are required of the employee for their job. Duties, responsibilities, and activities may change at any time with or without notice.

We're an equal-opportunity employer. All applicants will be considered for employment without attention to race, color, religion, sex, sexual orientation, gender identity, national origin, veteran or disability status.

***While this role is hybrid remote, the candidate MUST live in the Tampa/surrounding area as occasional travel to our corporate office is required