Healthcare Operations Specialist

7 days ago


Hollywood, Florida, United States Community Care Plan Full time
Job Description

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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