Payor Operations Specialist

Beth Israel Lahey Health • Wakefield, MA

3d • $79,040 - $93,600 • Onsite

About The Position

When you join the growing BILH team, you're not just taking a job, you’re making a difference in people’s lives.

Position Summary:

Reporting to the Director, Payor Operations, the Payor Operations Specialist, serves as a key member of the team. BILHPN provides support within our value based care agreements aimed at providing high quality care that is cost effective. The Payor Operations Specialist directs and manages Payor deliverables within our value based contracts. Serving Payor value based contract needs includes deliverable insight, contract opportunity evaluations, developing strong Payor partnerships, navigating and notification of Payor communications, consultation, Payor programs accountability, evaluations, and refinements.

Requirements

• A Bachelor’s Degree in Healthcare Management, Administration, Public Health, Business Administration, or other related functional area is required.
• 1-3 years of experience with Payor relationships, contract elements within value based care, or other related field within a healthcare environment required.
• Ability to make decisions that are guided by precedents, policies and objectives.
• Regularly makes decisions and recommendations on issues affecting a department or functional area.
• Ability to set goals and priorities for functional area.
• May make recommendations for department policies, practices and programs.
• Ability to communicate complex information in English effectively in writing to all levels of staff, management and external customers across functional areas.
• MS Office applications with advanced skills in Word, PowerPoint, Excel and Outlook required
• Ability to verbally communicate complex concepts in English and escalate sensitive situations and conflicts
• Ability to act as a team leader for Payor deliverable initiatives, creating a collaborative and respectful team environment and improving workflows.
• Results may impact the operations of one or more departments.
• Ability to provide a high level of customer service
• Strong organizational skills and the ability to articulate complex workflows and processes
• Experience with fast paced, high-visibility initiatives
• Ability to work with varying teams and communicate needs

Nice To Haves

• Experience with strategy and opportunity evaluation a plus.
• SmartSheet (preferred)

Responsibilities

• Partners with Director, Payor Operations, to provide internal consultative direction related to Payor opportunity and needs within our contracts
• Leads Payor deliverable oversight, including tracking and sending of deliverables and facilitation of deliverable needs where applicable
• Develop and optimize integration, in collaboration with respective teams, of applicable Payor needs and considerations across BILHPN
• Perform evaluations and gap analyses regarding Payor requirements to appropriately develop interventions that are needed to support contract requirements
• Grow and uphold Payor relationships, including Payor accountability, with Payor partners
• Navigate, develop, implement, and maintain – in partnership with Director, Payor Operations - processes on bi-directional communication avenues needed for Payor alerts, notifications, deliverables, or training
• Create action plans, roadmaps, and business cases for opportunity within the Payor space that needs to be addressed to perform appropriately
• Maintains inventory of Payor deliverables
• Manages Payor deliverables through the full lifecycle – planning, execution, monitoring, and completion
• Attends Payor specific meetings, including gathering of and updating materials
• Synthesizes and reviews Payor reporting packages to ensure BILHPN stakeholders are receiving what they need, with recommendations being sought through if adjusts are needed
• Refines current processes related to Payor requirements
• Assists with compilation of materials related to Payor requirements
• Leads communication efforts with Payor stakeholders
• Develop and maintain strong vendor relationships that support success within contracts
• Proactively support addressing impacts, barriers, and risks to deliverables
• Communicates content information appropriately to stakeholders, local leaders, administrators, support staff, BILHPN teams, and providers
• Build and maintain working relationships with internal teams, administrators, vendors, revenue cycle, Payors, practice operations, and provider community to foster collaboration and partnership in driving meaningful change within payor operations divisional areas
• Maintain strict adherence to the Lahey Health Confidentiality policy.
• Maintain strict adherence to all BILH and BILHPN Policies.
• Maintain courteous and effective interactions with colleagues and providers and stake holders.
• Demonstrate an understanding of the job description, performance expectations, and competency assessment.
• Demonstrate a commitment toward meeting and exceeding the needs of our customers and consistently adheres to customer service standards.
• Participate in departmental and/or interdepartmental quality improvement activities.
• Participate in and successfully completes Mandatory Education.
• Perform all other duties as needed or directed to meet the needs of the department.

Benefits

• As a health care organization, we have a responsibility to do everything in our power to care for and protect our patients, our colleagues and our communities. Beth Israel Lahey Health requires that all staff be vaccinated against influenza (flu) as a condition of employment.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level