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BCBS HMO Coordinator
2 months ago
We are seeking a highly skilled and detail-oriented Healthcare Operations Specialist to join our Payor Contracting/MA Management team at Duly Health and Care.
Key Responsibilities- Act as the primary liaison between payors and internal Duly operations, ensuring effective communication and collaboration.
- Coordinate responses to payor issues under the guidance of the Director of MA, facilitating timely resolution and follow-up.
- Collaborate with cross-functional teams to address payor-related Claims, Utilization Management, and Quality issues, driving towards optimal solutions.
- Conduct ad-hoc analysis and reporting to support delegated payor operations, leveraging data insights to inform strategic decision-making.
- Prepare and track monthly, quarterly, and annual submissions related to delegated payor operations, maintaining meticulous records.
- Stay informed about payor updates, changes, and industry trends, disseminating pertinent information to operational areas.
- Facilitate and manage payor meetings, including agenda preparation, documentation, and follow-up actions.
- Maintain provider directory submissions in alignment with delegated payor criteria, ensuring accuracy and compliance.
- Oversee the resolution of Payor complaints and PCP letter requests, upholding a high standard of customer service.
- Supervise and coordinate the yearly UM Fund Challenges process and MA reconciliation process, driving accountability and efficiency.
- Undertake additional duties and projects as assigned by management, demonstrating flexibility and adaptability.
- Bachelor's degree in a related field preferred.
- 2-3 years of experience in payor contracting, payor operations, or a similar role within the healthcare industry.
- Strong organizational and time management skills, with a keen attention to detail.
- Excellent written and verbal communication abilities, with proficiency in Microsoft Office Suite.
- Analytical mindset with the ability to interpret and analyze data effectively.
- Knowledge of healthcare industry dynamics and payor operations.
- Familiarity with project management principles and practices.
- Ability to work independently and collaboratively in a fast-paced, team-oriented environment.
- Strong problem-solving skills and a commitment to maintaining professionalism and confidentiality.
