Healthcare Operations Specialist
7 days ago
We are seeking a skilled Healthcare Operations Specialist to join our team at Community Care Plan. This role will be based in Broward County, Florida.
Key Responsibilities:
- Manage provider contracts and negotiate agreements to ensure successful collaboration between providers and the organization.
- Develop and implement education programs to improve provider network performance and address specific challenges.
- Monitor and analyze key program performance metrics, such as utilization, coding, and quality, to identify areas for improvement.
- Maintain accurate records of site visits, grievances, claims, and care delivery issues, and develop effective resolutions.
- Ensure compliance with NCQA requirements and standards, and provide ongoing support to providers in maintaining these standards.
- Collaborate with internal teams to resolve claims denials and improve claim submissions and provider data updates.
Requirements:
- Bachelor's degree in a related field.
- 3-5 years of experience in healthcare or insurance operations.
- Proven ability to communicate effectively with diverse stakeholders, including physicians, office managers, and other healthcare professionals.
- Strong analytical and problem-solving skills, with the ability to prioritize tasks and manage multiple projects simultaneously.
- Proficiency in Microsoft Office applications, particularly Word and Excel.
Compensation:
The estimated salary for this position is $70,000-$90,000 per year, depending on experience and qualifications.
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