Client Business Manager

The Client Business Manager at Guidehealth supports client success by assisting with client onboarding operational support and service this role youll work closely with clients health plans and internal teams to ensure seamless operations build strong relationships and contribute to Guidehealths mission of advancing value-based healthcare. Under the guidance of senior team members youll utilize data-driven tools to support delegated services and operational processes helping to achieve measurable outcomes in shared and full-risk arrangements. 

WHAT YOULL BE DOING 

• Working in a fully remote environment engaging virtually with clients health plans and internal
• Working in a fully remote environment engaging virtually with clients health plans and internal teams.
• Owning client onboarding ongoing operational support and service delivery for assigned clients from go live through steady state.
• Building and maintaining positive relationships with client administrators network providers and management teams to support satisfaction and retention.
• Managing the operational delivery of delegated services for assigned clients including Eligibility UM (non-clinical) PHM Claims Quality CX and Credentialing/Provider Relations. Serving as the primary point of accountability for delegated function performance.
• Ensuring regulatory and contract compliance across assigned clients. Preparing and delivering monthly delegated services report-outs and quarterly executive review materials. Supporting URAC HCAPA and health plan pre-delegation audit preparation.
• Tracking analyzing and reporting on operational data and performance metrics on a monthly cadence using Guidehealths applications and reporting tools to identify trends and drive issues to resolution across internal functions.
• Owning eligibility capitation and reconciliation processes for assigned clients coordinating with Finance and Eligibility to resolve discrepancies.
• Contributing to new client implementations scope expansions and cross-client initiatives such as platform transitions network builds and accreditation renewals.
• Tracking SLA performance against contract requirements for every assigned client. Identifying gaps driving remediation with internal owners and reporting status to the client and internal leadership. Maintaining 100% SLA compliance as the standing team goal.
• Leading client operational meetings and participating in UM committees JOCs and monthly close meetings for assigned clients.
• Conducting regular client check-ins satisfaction reviews and quarterly executive business reviews. Tracking CSAT and NPS against annual targets.
• Serving as the escalation owner for claim denials authorization issues eligibility questions provider complaints roster discrepancies payment issues and other client operational issues driving resolution with the responsible internal team.
• Supporting renewal cycles including SLA restructuring PMPM negotiation input scope expansion proposals and BAA updates. Tracking assigned clients in the Renewals Master Tracker.
• Representing Guidehealth at BCBSIL summer and winter forums and translating regulatory and program changes (risk model MSA prior auth submissions) into operational actions for assigned clients.
• Maintaining accurate client contract documentation DORs SOWs and SLA schedules for the assigned portfolio.
• Contributing to team-wide operational improvements including paper claims reduction EFT/ERA adoption OON reduction 039 denial workthrough and similar initiatives.
• Managing daily work using multiple systems including EMR systems payer portals Guidehealth applications and Microsoft 365 (Excel Word PowerPoint Outlook Teams).
• Collaborating with internal teams to deliver integrated services and a consistent client experience.

Qualifications :

WHAT YOULL NEED TO HAVE 

• Bachelors degree preferred; Associate degree or equivalent experience considered. 
• 3 years of experience in healthcare operations managed care IPA operations health plan operations or a related field. 
• Experience owning or contributing meaningfully to client facing operational work with demonstrated accountability for outcomes. 
• Demonstrated verbal and written communication skills including the ability to listen actively run structured client meetings and communicate clearly with clients health plan partners and cross-functional teams. 
• Strong organizational skills and the ability to track multiple workstreams deadlines and deliverables across a client portfolio. 
• Strong analytical and problem solving skills with the ability to work through operational issues across multiple functions and stakeholders. 
• Ability to manage a portfolio of clients and competing priorities independently in a fast paced environment. 
• Proficiency in Microsoft 365 (Excel Word PowerPoint Outlook Teams) and ability to learn multiple systems. 
• Drivers license and reliable transportation (25% travel in Chicago area required). 

WOULD LOVE FOR YOU TO HAVE 

• Direct experience with delegated services (UM Claims Credentialing Eligibility PHM Quality or CX) in an IPA health plan or delegated entity setting. 
• Familiarity with value based care contracts (shared savings full risk capitation) and PMPM based service arrangements. 
• Experience with SLA tracking contract compliance reporting and health plan or NCQA/URAC audit preparation. 
• Familiarity with claims workflows eligibility files (834) capitation reconciliation and payer portals. 
• Experience presenting operational and executive level reporting to client leadership. 
• Basic knowledge of EMR systems and healthcare data platforms. 

Additional Information :

The salary for this role is $65000 to $70000 per year

ALIVE with Purpose: How We Thrive at Guidehealth 

At Guidehealth our values come to life in everything we do. 

• We are Driven by Accountability grounded in transparency reliability and integrity as we navigate challenges and opportunities alike. 
• Always Growing Always Learning staying curious and continuously improving inspires us to shape a better future for healthcare. 
• With Collaborative Innovation we solve problems creatively making every experience better for our employees and the patients we serve. 
• At Guidehealth Every Voice Matters we believe our collective strength is rooted in the unique perspectives of each team member. 
• And through Empathy in Action we build stronger connections with those who count on us. 
• This is what it means to be ALIVE with purpose. This is how we thrive together at Guidehealth. 

BENEFITS:

While you are hard at work advancing value-based healthcare we are here to ensure YOU have the care you and your family need and the opportunities for growth and development. Our commitments to you include:

• Work from Home: Guidehealth is a fully remote company providing you the flexibility to spend less time commuting and more time focusing on your professional goals and personal needs.
• Keep Health a Priority: We offer comprehensive Medical Dental and Vision plans to keep you covered.
• Plan for the Future: Our 401(k) plan includes a 3% employer match to your 6% contribution.
• Have Peace of Mind: We provide Life and Disability insurance for those just in case moments. Additionally we offer voluntary Life options to keep you and your loved ones protected.
• Feel Supported When You Need It Most: Our Employee Assistance Program (EAP) is here to help you through tough times.
• Take Time for Yourself: We offer paid time off plans helping you achieve work-life balance and meet your personal goals.
• Support Your New Family: Welcoming a new family member takes time and commitment. Guidehealth offers paid parental leave to give you the time you need.
• Learn and Grow: Your professional growth is important to us. Guidehealth offers various resources dedicated to your learning and development to advance your career with us.

All full-time employees of Guidehealth who work 30 hours per week or more are eligible for our comprehensive benefits package. Temporary employees and contractors are not eligible for benefits.

COMPENSATION:

The listed compensation range listed is paid bi-weekly per our standard payroll practices. Final base pay decisions are dependent upon a variety of factors which may include but are not limited to: skill set years of relevant experience education location and licensure/certifications.

OUR COMMITMENT TO EQUAL OPPORTUNITY EMPLOYMENT 

Diversity inclusion and belonging are at the core of Guidehealths values. We are an equal opportunity employer. We enthusiastically accept our responsibility to make employment decisions without regard to race religious creed color age sex sexual orientation and identity national origin citizenship religion marital status familial status physical sensory or medical disability Family and Medical Leave military or veteran status pregnancy childbirth or other related medical conditions or any other classification protected by federal state and local laws and ordinances. Our management is fully dedicated to ensuring the fulfillment of this policy with respect to hiring placement promotion transfer demotion layoff termination recruitment advertising pay and other forms of compensation training and general treatment during employment. 

OUR COMITTMENT TO PROTECTION OF PATIENT AND COMPANY DATA

This position is responsible for following all Security policies and procedures in order to protect all PHI and PII under Guidehealths custodianship as well as Guidehealth Intellectual Properties.  For any security-specific roles the responsibilities would be further defined by the hiring manager. 

As a remote-first organization handling sensitive healthcare data Guidehealth verifies candidate identity at multiple stages of the hiring and onboarding to safeguard patient privacy data security and compliance requirements.

REMOTE WORK TECHNICAL REQUIREMENTS

Guidehealth is a fully remote company. We provide new employees with the necessary equipment to function in their role at no charge to the employee. Employees provide their own internet connection capable of conducting video calls on camera and connecting to various internal and external systems. The required internet speed is a minimum of 100 mbps download 10 mbps upload. Please run a speed test here to confirm your internet connection meets these requirements. 

SECONDARY EMPLOYMENT

At Guidehealth we value transparency and collaboration as part of our commitment to excellence. As your primary employer we kindly ask all team members to disclose any secondary employment regardless of whether it may present a potential conflict of interest. 

To ensure smooth teamwork and availability employees must be accessible during our stated working hours. We foster connection and engagement by asking team members to join virtual meetings with their cameras on.

Remote Work :

Yes

Employment Type :

Full-time