Health Plan Operations Specialist

Our mission is Better Health. Our passion is helping others.

Whats Your Why

Are you looking for a career opportunity that will help you grow personally and professionally

Do you have a passion for helping others achieve Better Health

Are you ready to join a growing team that shares your mission

Why Join Our Team: At Better Health Group its our commitment our passion and our culture that sets us apart. Our Team Members make a difference each and every day! They support our providers and payors ensuring they have the necessary tools and resources to always deliver best-in-class healthcare experiences for our patients. We dont just talk the talk - we believe in it and live by it. Be part of a team that shares your passion and drive and start living your purpose at Better Health Group.

Position Objective

The Health Plan Liaison serves as the primary operational link between Better Health Group its affiliated primary care physician (PCP) offices and assigned health plan partners. Reporting to the Manager Operations the incumbent manages intake research and resolution of health plan-related inquiries for assigned PCP offices working directly with health plan representatives and internal teams to resolve issues affecting provider operations member access and the overall health plan partnership.

The position also strengthens these partnerships by coordinating and facilitating Health Plan Joint Operations Committee (JOC) meetings supporting health plan onboarding and the Annual Enrollment Period (AEP) and developing and maintaining health plan resource documents and quick reference guides used by internal teams and PCP offices. Through strong relationship management sound judgment and proactive communication the Health Plan Liaison helps ensure health plan policies and procedures are clearly understood and consistently applied recurring issues are identified and escalated and Better Health Group maintains productive collaborative relationships with its health plan partners.

Responsibilities

Health Plan Inquiry Management and Issue Resolution

• Serve as the primary point of contact for assigned PCP offices regarding health plan-related inquiries issues and requests.

• Manage the intake of health plan-related inquiries through the internal ticketing process maintaining accurate status tracking from receipt through resolution.

• Research and investigate inquiries ranging from routine to complex coordinating with health plan representatives and internal teams to resolve issues and escalating to leadership as needed.

• Identify recurring issues trends and process gaps across PCP offices and health plans and recommend improvements to leadership.

• Maintain current knowledge of health plan-specific policies procedures requirements and resources and communicate relevant changes to PCP offices and internal teams.

• Build and foster positive collaborative relationships with PCP offices health plan partners and internal teams.

Health Plan Partnership and Joint Operations Committees

• Schedule and lead Joint Operations Committee meetings

• Prepare meeting agendas and presentations and distribute them to attendees in advance of each meeting.

• Document meeting action items distribute them to attendees following each meeting and track open items through completion.

• Maintain accurate agendas and action-item records for recurring operational meetings.

• Maintain professional and responsive working relationships with internal and external stakeholders to support effective communication and service delivery.

Health Plan Onboarding AEP and Resource Development

• Facilitate the health plan onboarding process as needed coordinating required information communications and follow-up among the health plan PCP offices and internal teams.

• Support tasks associated with the Annual Enrollment Period (AEP) process each year.

• Create update and maintain Health Plan Resource documents and quick reference guides that compile information from multiple health plans into a single resource for internal and external users.

• Identify the need for new or updated resources based on requests and recurring questions received from internal teams and PCP offices.

• Attend and participate in Core Operations team meetings health plan meetings and interdepartmental market meetings as required.

• Perform additional duties as assigned.

Position Requirements / Skills

• High school diploma or equivalent required; Associates or Bachelors degree in Healthcare Administration Business Administration or a related field preferred.

• 3 years of experience in a healthcare-related environment; experience with health plans managed care Medicare Advantage or provider relations preferred.

• Working knowledge of health plan operations policies and procedures preferred.

• Proficiency in Google Workspace (Drive Docs Sheets Slides) and Microsoft Office (Word Excel PowerPoint) including experience maintaining trackers presentations and reference documents.

• Ability to research and resolve issues of varying complexity exercise sound judgment and determine when escalation is appropriate.

• Ability to work cross-functionally with multiple teams and to work independently with minimal supervision.

• Excellent organizational time-management and multi-tasking skills with strong attention to detail.

• Excellent written and verbal communication skills; must be comfortable communicating with internal and external stakeholders providers and health plans.

• Strong interpersonal meeting facilitation and presentation skills.

• Strong critical thinking and problem-solving skills.

• Ability to adapt to shifting priorities in a fast-paced environment.

• Must be results-oriented with a focus on quality execution and delivery.

• Demonstrated ability to maintain confidentiality when handling sensitive provider member and business information.

• Appreciation of cultural diversity and sensitivity toward team members providers and the patient populations served.

Physical Requirements

• Ability to remain in a stationary position primarily sitting for extended periods while performing computer-based and administrative work.

• Ability to regularly operate a computer keyboard mouse telephone and other standard office equipment.

• Ability to communicate and exchange information in person by telephone and through virtual communication platforms.

• Ability to review electronic records spreadsheets and detailed documentation for accuracy and completeness.

• Ability to occasionally stand walk bend and reach while performing routine office activities.

• Ability to occasionally lift or carry office materials weighing up to 15 pounds.

Key Attributes/ Skills:

• Has a contagious and positive work ethic inspires others and models the behaviors of core values and guiding principles.

• An effective team player who contributes valuable ideas and feedback and can be counted on to meet commitments.

• Is able to work within our Better Health environment by facing tasks and challenges with energy and passion.

• Pursues activities with focus and drive defines work in terms of success and can be counted on to complete goals.

Please note this job description is not designed to cover or contain a comprehensive listing of activities duties or responsibilities required of the employee for this job. Duties responsibilities and activities may change at any time with or without notice.