Senior Healthcare Operations Account Specialist

Payer Relationship Management

• Proactively manages payer accounts.
• Routinely communicates with payer and responds to incoming calls/emails regarding data files, errors, member engagement strategies, and other related inquiries.
• Able to address payer and/or local YMCA queries regarding contract relationship, and if he/she does not know the answer can quickly and appropriately liaison with team members to find solution.
• Assist MSO leadership in developing account relationships with executive level and operational payer contacts to document needs and priorities. Specifically creating a partnership environment
• Has a professional presence in front of payers and vendors.  Handles expectations on a regular basis through constant communications.

Payer Implementation

• Demonstrates an understanding of the claim files and electronic medical record system, after training on athenanet is provided.
• Gather payer requirements for network set up and work with athena health, our electronic medical record partner, to implement these requirements (e.g., confirmation of NPIs, correct payment submissions, EFTs, etc.)
• Use internal reporting to perform error analysis for payer related and overall account errors.

Billing/Reporting

• Create, review and submit monthly invoices for select payers
• Assist in development and responsible for submission of monthly outcome reporting to all payers
• Complete regular DPP benefit eligibility checks between payer eligibility files and enrollment reports from electronic medical record system for selected payer accounts.

Business Development/Contract Management

• Assist in increasing penetration of YMCA’s DPP and other chronic disease prevention products
• Develop an understanding of competitor’s products and services.
• Gain familiarity with payer contracts and support MSO and local YMCA leadership in contract negotiations and implementation
• Other duties as assigned