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Relationship Coordinator

1 month ago

Philadelphia, Pennsylvania, United States Pyramid Consulting Full time
Job Title: Relationship Coordinator

We are seeking a skilled Relationship Coordinator to join our team at Pyramid Consulting, Inc. This is a contract opportunity with long-term potential, located in Philadelphia, PA (Onsite).

Job Summary:

The Relationship Coordinator will serve as a liaison between clients and our organization, resolving problems related to service delivery, claims processing, and procedural issues. This role requires strong communication and problem-solving skills, as well as the ability to work effectively in a team environment.

Key Responsibilities:
  • Resolve common, complex, and escalated issues impacting client Out-of-Area (HOST) provider claims by working with other BCBS Health Care Plans or internal business teams.
  • Track issues, provide root cause analysis, and escalate to Management to address issues at a National level.
  • Partner with client provider teams to achieve timely issue resolution and compliance with BCBS Health Care Plans' benefits requirements.
  • Take ownership of resolving partner plan inquiries from start to completion, including assistance from other internal areas.
  • Act as a liaison between Client and all partner BCBS Health Care Plans to ensure end-to-end resolution of issues for all claims in accordance with Inter-Plan Program (IPP) requirements.
  • Identify and aid in establishing business requirements for system updates/changes to eliminate operational issues.
  • Collect information related to issues and provide recommendations for educational material for the client provider community.
  • Use internal reporting tools to manage, analyze, and perform trend analysis of open and closed inventory to meet BCBS Association requirements.
  • Receive, track, and research Director-level and above escalations for timely resolution in accordance with BCBSA escalation guidelines.
Requirements and Technology Experience:
  • Skills-Blue Card experience, Claims/Service operations environment, and Inter-Plan policies.
  • High School Diploma or GED, 4 years' experience in a Claims/Service operations environment, or a bachelor's degree, 2 years' experience in Claims/Service environment.
  • Demonstrated understanding of Inter-Plan policies, processing standards, and guidelines, including Host and Home responsibilities.
  • Demonstrated understanding of all Inter-Plan Systems.
  • Demonstrated understanding of Products, including Medicare Advantage, Medicare Cross-over, State Health Plan, Administrative Services Only (ASO), and Fully insured and Individual products, National Accounts Database.
  • Experience in the development, design, and execution of account-specific, customized education programs in the healthcare industry is preferred.

Pyramid Consulting, Inc. 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.