Bundled Payment Program Assoc

Florida Blue

About The Position

The Bundled Payment Program Associate is responsible for working directly with clients to ensure superior support and delivery of unique health benefit programs. Provides daily client support, as well as regular reviews of business processes, product performance metrics, identification of potential opportunities, and enhancements to the product line. Develops and maintains highly effective client/provider partner relationships while delivering high quality customer service to members participating in Bundled Payment Programs. What Will You Be Doing: Serves as Care Concierge / Member Advocate to directly help members navigate the programs administered by WebTPA. Outlines the program to members who make outreach either through telephone or email, books required travel for participating members, supports them through their entire their surgical journey, and documents all relevant interactions for tracking purposes. Engages via phone and email with healthcare provider contacts as well in support of the member experience. Serves as initial point of contact for daily client interactions with client contacts. Develops strong relationships with client contacts to inspire trust, confidence and ongoing partnership and collaboration Assists with the timely preparation of client agreements, including administrative service agreements, scope of work documents, business associate agreements, and plan documents. Contributes to department leadership’s business development efforts by assisting with presentation and proposal development, RFP questionnaire responses, and in-person participation in sales meetings. Prepares and assists with the presentation of client-facing documents, including process workflows, project updates, and report packages, and track deliverables resulting from these meetings Supports efficient and effective workflows, accurate reporting, industry best practices, and adherence to legal requirements Receives claims detail from client contacts, reviews for accuracy, and coordinates with internal teams, including Eligibility, Mailroom/Data Entry, and Finance, to ensure timely and accurate processing of all claims. Documents department processes and procedures, updating documentation on a regular basis. Provides quality assurance support to Program Manager to ensure accuracy of reporting, communications, and process documentation Assists Program Manager in managing day-to-day client requests, report development and meeting scheduling. Responds to client inquiries promptly, accurately and concisely acknowledging and building expectations for resolution. Quickly addresses each reported issue, evaluating the relative urgency and escalating as necessary. Escalates urgent or complex member and client issues to the Program Manager in a timely manner and assist with developing solutions to issues Actively participates in weekly team meetings to communicate project status, report on member updates, help Program Manager prioritize efforts, and assist with identifying potential upcoming challenges Engages with others on the team to maintain a full understanding of the volume, challenges, and successes of member, client and provider interactions. Participates in feedback loop discussions and provide recommendations for process improvement on a regular basis

Requirements

2+ years related work experience in Client Services, Customer Service or Claims functions
High school diploma or GED required.
Extensive experience and a high level of proficiency in Microsoft Office applications including Outlook, Word, PowerPoint and Excel
Strong verbal and written communication skills; ability to tailor communications based on audience and business objectives
Strong teamwork and collaboration skills, especially in cross-functional teams
Ability to maintain confidentiality and compliance with HIPAA requirements
Strong customer service skills.
Ability to work independently/autonomously and proactively as well as collaboratively as a team member.
Ability to maintain a high level of energy, enthusiasm, eagerness to learn and passion for client advocacy and service.
Strong attention to detail and commitment to accuracy.
Ability to prioritize independently on a regular basis and access appropriate resources to identify and address priority conflicts as necessary.

Nice To Haves

Bachelor’s degree in a related field Concentration in Business, Communications, or related field
Detailed knowledge of general TPA operations and all product components supporting Health Benefit Plans, including Claims, Customer Service, Client Accounting, Information Technology, Healthcare Spending Accounts, Care Management, Pharmacy Benefit Management, and HIPAA.
Proficiency and experience in the WebTPA's claims system.

Responsibilities

Serves as Care Concierge / Member Advocate to directly help members navigate the programs administered by WebTPA.
Outlines the program to members who make outreach either through telephone or email, books required travel for participating members, supports them through their entire their surgical journey, and documents all relevant interactions for tracking purposes.
Engages via phone and email with healthcare provider contacts as well in support of the member experience.
Serves as initial point of contact for daily client interactions with client contacts.
Develops strong relationships with client contacts to inspire trust, confidence and ongoing partnership and collaboration
Assists with the timely preparation of client agreements, including administrative service agreements, scope of work documents, business associate agreements, and plan documents.
Contributes to department leadership’s business development efforts by assisting with presentation and proposal development, RFP questionnaire responses, and in-person participation in sales meetings.
Prepares and assists with the presentation of client-facing documents, including process workflows, project updates, and report packages, and track deliverables resulting from these meetings
Supports efficient and effective workflows, accurate reporting, industry best practices, and adherence to legal requirements
Receives claims detail from client contacts, reviews for accuracy, and coordinates with internal teams, including Eligibility, Mailroom/Data Entry, and Finance, to ensure timely and accurate processing of all claims.
Documents department processes and procedures, updating documentation on a regular basis.
Provides quality assurance support to Program Manager to ensure accuracy of reporting, communications, and process documentation
Assists Program Manager in managing day-to-day client requests, report development and meeting scheduling.
Responds to client inquiries promptly, accurately and concisely acknowledging and building expectations for resolution. Quickly addresses each reported issue, evaluating the relative urgency and escalating as necessary.
Escalates urgent or complex member and client issues to the Program Manager in a timely manner and assist with developing solutions to issues
Actively participates in weekly team meetings to communicate project status, report on member updates, help Program Manager prioritize efforts, and assist with identifying potential upcoming challenges
Engages with others on the team to maintain a full understanding of the volume, challenges, and successes of member, client and provider interactions. Participates in feedback loop discussions and provide recommendations for process improvement on a regular basis