Healthcare Operations Specialist (Value-Based Care)

Complete Health•Vestavia Hills, AL

43d•$17 - $20

About The Position

The Healthcare Operations Specialist (Value-Based Care) plays a key role in supporting value-based care initiatives by ensuring accurate Medicare Advantage attribution, payer alignment, and a strong patient experience across multiple clinics. This role sits at the intersection of healthcare operations, insurance coordination, and patient advocacy. The ideal candidate is detail-oriented, proactive, and comfortable navigating complex healthcare and insurance workflows. They enjoy solving operational problems, working cross-functionally with clinics and internal teams, and contributing to continuous improvement efforts that directly impact access to care, provider performance, and patient satisfaction.

Requirements

General knowledge of primary care practices, Medicare Advantage, and healthcare operations
Strong communication, collaboration, and conflict-resolution skills
Ability to analyze information, resolve issues, and document accurately
Professionalism in emotionally sensitive or complex patient interactions
Adaptability to changing workflows and operational priorities
High school diploma or GED required
Minimum of 2 years of experience in a medical clinic, healthcare operations, or patient-facing healthcare role
Strong computer skills and proficiency with Microsoft Office and EHR systems
Strong understanding of Medicare Advantage plans (HMO, PPO, C-SNP, D-SNP)

Nice To Haves

Experience with Athena EMR, payer portals, and workflow tools (preferred)

Responsibilities

Support payer transitions, attribution clean-up efforts, and roster correction initiatives to ensure accurate VBC alignment and data integrity
Participate in roster data verification and validation processes
Process PCP change forms and assist with payer submissions
Track attribution updates and support internal audits
Validate and update insurance information in Athena EMR and payer portals
Support patient enrollment and retention efforts during Medicare AEP, OEP, and ROY
Manage patient calls related to coverage, cost, and plan concerns
Facilitate warm hand-offs to licensed brokers when appropriate
Track interactions, outcomes, and enrollment confirmations per department processes
Internally support clinics with plan coverage and eligibility questions
Work closely with Practice Transformation leadership on prioritization and execution of initiatives
Collaborate with Patient Advocates, Patient Access Center staff, clinic leadership, and external partners
Participate in meetings, training sessions, and workshops as required
Ensure compliance with HIPAA and all company policies and procedures