Operations Coordination Specialist

1 week ago


Worcester, Massachusetts, United States Central Mass Health LLC Full time
Job Overview

Central Mass Health LLC is a prominent Medicare Advantage health plan dedicated to providing quality healthcare services. We are currently seeking an Operations Support professional to enhance our Operations team. This role is pivotal in overseeing the planning, directing, monitoring, and coordination of the Operations department's functions, which encompass claims processing, vendor oversight, member services, enrollment, and overall member experience.

The Operations Support position will be responsible for managing daily operational tasks and large-scale projects, ensuring that all functions are completed accurately and in a timely manner. Additionally, this role will involve preparing departmental reports, analyzing data, and providing strategic recommendations to senior management based on findings.

Key Responsibilities
  • Coordinate and assist with compliance activities related to state, federal, NCQA, and organizational requirements, including conducting annual due diligence audits.
  • Schedule and execute operational audits, ensuring accurate completion of audit tools and reporting outcomes to management.
  • Monitor compliance of delegated activities post-audit, tracking reports from external entities and assisting in the development of Corrective Action Plans as necessary.
  • Create monthly scorecards to assess compliance with Delegation Oversight activities and evaluate delegate performance metrics.
  • Manage volume and production planning, develop tools for process improvement, and analyze data to support operational departments.
  • Lead strategic analysis and implementation efforts, ensuring data validity and relevance for operational decision-making.
  • Guide the department in establishing procedures and policies that align with long-term operational goals.
  • Oversee claims payment accuracy, managing the tracking of open issues with vendors until resolution.
  • Regularly report on Key Performance Indicators (KPIs) and establish best practices for claims payment methodologies in accordance with CMS regulations.
  • Conduct root cause analyses on systemic issues, formulating action plans to prevent incorrect payments.
  • Prepare comprehensive reports for regulatory agencies regarding provider disputes and claims-related inquiries.
  • Identify trends within the operational environment to enhance the member experience.
Qualifications

Education and Experience:

Bachelor's degree from an accredited institution or five years of relevant experience in operations, preferably within a Managed Care or Medicare Advantage context.

Additional Qualifications:

  • A minimum of five years of experience in operations within a Managed Care or Medicare Advantage setting is preferred.
  • In-depth knowledge of Medicare regulations and operational functions within a health plan is essential.


  • Worcester, Massachusetts, United States Central Mass Health LLC Full time

    Job OverviewCentral Mass Health LLC is a prominent Medicare Advantage health plan dedicated to providing exceptional healthcare services. We are currently seeking an Operations Support professional to enhance our Operations team. This role is crucial in assisting with the planning, directing, monitoring, and coordination of various operational functions...


  • Worcester, Massachusetts, United States Kaleidoscope ABA Therapy Services Full time

    Position OverviewLocation: RemoteCategory: Administrative ManagementEducation: Bachelor's Degree RequiredJoin a dynamic and expanding organization as Kaleidoscope ABA Therapy Services seeks a dedicated individual to fill the role of Operations Coordinator.The Operations Coordinator plays a crucial role within the organization, contributing to the mission of...


  • Worcester, Massachusetts, United States Central Mass Health LLC Full time

    Job OverviewCentral Mass Health LLC is a leading Medicare Advantage health plan dedicated to providing exceptional healthcare services. We are currently seeking an Operations Support professional to enhance our Operations team. This role is pivotal in overseeing the planning, execution, and coordination of various operational functions within our...


  • Worcester, Massachusetts, United States Veterans Inc Full time

    At Veterans Inc., we hold the conviction that we were there for our veterans when they needed us, and now we must support them in return. As the foremost provider of supportive services to Veterans and their families in New England, we are looking to welcome a dedicated Facilities Operations Specialist to our team.This role operates under the general...


  • Worcester, Massachusetts, United States Family Health Center Full time

    Position OverviewThis is a full-time, 40-hour per week position.Role Summary: The HR Operations Specialist is responsible for executing a variety of administrative tasks, operating with minimal oversight. This position necessitates regular interaction with personnel, candidates, and interns. Responsibilities may include managing benefits accrual, balancing...


  • Worcester, Massachusetts, United States University of Massachusetts Full time

    Overview GENERAL SUMMARY OF POSITION: The administrative team at the University of Massachusetts is dedicated to providing essential support to our researchers, enabling them to concentrate on their scientific endeavors. Leveraging a diverse range of skills and expertise, we deliver professional and comprehensive assistance in areas such as...


  • Worcester, Massachusetts, United States UnitedHealth Group Full time

    Join UnitedHealth Group, a leader in the healthcare industry, where we prioritize the well-being of our patients and team members alike. As part of our commitment to enhancing the quality and efficiency of healthcare, we invite you to be a part of our dedicated team.The **Healthcare Operations Coordinator** will oversee the daily functions of the Orthopedics...


  • Worcester, Massachusetts, United States University of Massachusetts Full time

    Overview GENERAL SUMMARY OF POSITION: The administrative team at the University of Massachusetts plays a crucial role in facilitating research efforts by providing essential support to our investigators. Our diverse expertise allows us to deliver comprehensive assistance in areas such as management, financial oversight, human resources, laboratory...


  • Worcester, Massachusetts, United States Commonwealth Electrical Technologies Full time

    Commonwealth Electrical Technologies is looking for a dedicated full-time Construction Operations Coordinator to excel in a dynamic office environment and deliver proactive and thorough support. Ideal candidates should exhibit exceptional organizational abilities, meticulous attention to detail, and effective communication skills, demonstrating a proactive...


  • Worcester, Massachusetts, United States University of Massachusetts Full time

    Overview GENERAL SUMMARY OF POSITION: The administrative team at the University of Massachusetts is dedicated to providing essential support to our researchers, enabling them to concentrate on their scientific endeavors. Our diverse expertise allows us to deliver professional assistance in management, financial oversight, grant accounting, human...


  • Worcester, Massachusetts, United States FMC Ice Sports Full time

    Become a Key Player as an Operations SpecialistJoin Our Esteemed OrganizationMake a Difference in Your Community - Engage in Meaningful WorkFacility Management Corporation, recognized as "FMC Ice Sports," has been committed since its inception to expertly manage and operate premier ice sport venues. Our mission is to deliver programs that not only enrich our...


  • Worcester, Massachusetts, United States Associated Home Care Full time

    Job Summary:The Scheduling Coordinator - Client Care Specialist will be responsible for coordinating the schedules of assigned clients and caregivers, ensuring seamless delivery of high-quality services. This role requires strong communication and problem-solving skills, with a focus on customer satisfaction and service excellence.Key...


  • Worcester, Massachusetts, United States UMass Med School Full time

    Building Systems Operations SpecialistPOSITION SUMMARY:Under the guidance of the Lead Operating Engineer or designated representative, the Building Systems Operations Specialist is tasked with ensuring the safe and efficient functioning of the facility and its operational systems. This role involves addressing all facility-related issues reported by...


  • Worcester, Massachusetts, United States Veterans Inc. Full time

    Job OverviewVeterans Inc., recognized as the leading provider of services to veterans and their families across New England, is seeking a dedicated, highly driven, and skilled individual to take on the role of Operations Coordinator and contribute to the mission of Veterans Inc.Reporting directly to the Senior Operations Manager, this role is essential in...


  • Worcester, Massachusetts, United States UMass Med School Full time

    Building Systems Operations SpecialistPosition Overview:Under the guidance of the Lead Operating Engineer or designated representative, the Building Systems Operations Specialist is tasked with ensuring the safe and efficient functioning of the facility and its associated systems. This role involves addressing all facility-related issues reported by staff,...


  • Worcester, Massachusetts, United States Veterans Inc. Full time

    Position OverviewVeterans Inc., a leading provider of services for veterans and their families across New England, is seeking a dedicated, proactive, and skilled individual to take on the role of Operations Coordinator and contribute significantly to our mission.Reporting directly to the Senior Operations Manager, this role is essential in supporting the...


  • Worcester, Massachusetts, United States Aramark Full time

    About the RoleWe are seeking a highly organized and detail-oriented Culinary Operations Specialist to join our team at Aramark. As a key member of our culinary team, you will be responsible for providing administrative support to our chefs and kitchen staff, ensuring the smooth operation of our food service operations.Key ResponsibilitiesVendor Management:...


  • Worcester, Massachusetts, United States InsideHigherEd Full time

    Position Overview:POSITION SUMMARY:Under the guidance of the Principal Investigator (PI) or their designated representative, the Laboratory Research Specialist is responsible for providing essential operational support within the research environment. This role involves executing research experiments as outlined by the PI.This is an open-level position,...


  • Worcester, Massachusetts, United States InsideHigherEd Full time

    Position Overview:POSITION SUMMARY:Under the guidance of the Principal Investigator (PI) or their designated representative, the Laboratory Research Specialist offers essential operational assistance to the research facility. The Specialist will conduct experimental research as outlined by the PI.This position is open to various ranks (there are 4 levels of...


  • Worcester, Massachusetts, United States Veterans Inc. Full time

    Job OverviewVeterans Inc., a leading provider of services to veterans and their families across New England, is seeking a dedicated, proactive, and skilled individual to take on the role of Operations Coordinator and contribute significantly to our mission.This role, under the guidance of the Senior Operations Manager, is essential in facilitating the...