Recruiter / Manager

Operations Specialist - Aspire Health Plan

Job Description

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 Job Title: Operations Specialist - Aspire Health Plan
 Company Name: Community Hospital of the Monterey Peninsula
 Employment Type: Full Time (Exempt)
 Location: MONTEREY, CA, United States
 Salary: Highly Competitive
 Shift Hours/ Days: Mon - Fri, 8:00 a.m. - 5:00 p.m.
 Hours/Pay Period: 80
 Degree Required: A.A.
 Job ID: 13-0179
 Date Posted: May 28, 2013
 Years Experience: 5
 Hot Jobs: Yes
 Facility / Location: Aspire
 Note:  Please read the complete description below before applying for this job.
  Complete Description

Company Overview

The Aspire Health Plan is an affiliate of the Community Hospital of the Monterey Peninsula (CHOMP).  Aspire is introducing a new Medicare Advantage product line in 2014 to serve the needs of the Medicare eligible population in Monterey County. This population segment of our community represents one of the fastest growing segments of the county in coming years, and their demands for comprehensive health care and maintaining overall wellness are growing with their increasing numbers. By offering  attractive Medicare Advantage plans, Aspire will round out the services CHOMP already provides, creating value added services for seniors to achieve the triple aim of improving care for the individual, reducing cost, and improving the health of the community.

In addition, by keeping senior's health care dollars in the community through local plan administration, there will be better reimbursement for high quality care from physicians and other health care workers that further improves access to that care for patients and a reasonable cost.

Summary of Position:

The Operations Specialist is responsible for providing direct support to external clients of Aspire Health Plan.  In addition, the Operations Specialist provides administrative and departmental support to the Director of Care Management, Director of Analytics and the Chief Operating Officer of AspireHealth. 

Responsibilities

  • Provide excellent customer service to our clients.
  • Receive, place and transfer telephone calls appropriately. Handle telephone information requests with courtesy, accuracy and respect.
  • Answer all Network calls to include determining provider "Network Status", pricing requests, & contract inquires.
  • Answer all Third Party Administrator, office manager, and member questions received via email, fax & telephone to include maximum allowable, Network status, and verification of provider practice information.
  • Provide coverage for Care Management Specialist to include entering information required to issue Pre-Certs into Cypress Health Track, issuing Pre-Certs, & answering all Care Management calls.
  • Trouble shoot member pharmacy calls with pharmacy vendor and call member back with resolution.
  • Continually monitor and update provider database to ensure all information is accurate and up-to-date.
  • Work with Director of Analytics to ensure web directories are accurate and up-to-date.
  • Coordinate provider application, credentialing, and contracting process.
  • Ensure provider applicant information is transmitted to external credentialing service in a complete and timely manner.
  • Track and follow-up on "pending" provider applications, credentialing, & contracting.
  • Maintain Network Provider, Facility, & Hospital contract files.
  • Responsible for Contract Committee and Board meeting set up to include, but not limited to, sending out Save-the-Date notices, preparing the meeting packets, and preparing the minutes.
  • Responsible for Network section of the client newsletter to include writing, formatting and collaboration with other staff to meet specified deadline.
  • Maintain provider application files.
  • Develop, track, & follow-up on Monthly Third Party Administrator Audits.
  • Develop, track, & follow-up on Provider Audits.
  • Work with Director of Analytics & Medical Director to distribute annual Fee Schedule Update.
  • Responsible for writing and up-dating HIPAA policies & procedures and placing on a shared drive.
  • Responsible for writing and up-dating all Network policies & procedures and placing on a shared drive.
  • Support preparation and distribution of correspondence, proposals, reports, spreadsheets and forms in a timely manner.
  • Prioritize and plan work for completion in a timely manner, coordinating with others as needed and meeting deadlines set on all phases of work.
  • Develop excellent professional relationships with our provider, hospital, and   insurance company partners.
  • Maintain a high level of professionalism, safeguarding and preserving the confidentiality of all information in accordance with HIPAA regulations.
  • Demonstrate a consistent level of performance; strive to maintain a steady level of productivity with a consistent effort, a high degree of accuracy and thorough attention to detail at all times.
  • Demonstrate the ability to adapt to changes in the workload and responsibilities.
  • Perform other activities and function as defined by the Chief Operating Officer

Ppossition Requirements

  • Minimum A.A. degree or equivalent practical experience in related or similar positions.
  • At least five years' experience in a clinical or medical office environment, with two or more years in support of multiple managers and/or department heads.
  • Working knowledge of healthcare policies, procedure and regulations, general office and administrative procedures. 
  • Business English and/or technical vocabulary related to health care industry (insurance/medical terminology).
  • Ability to operate computer equipment and software programs necessary to fulfill position responsibilities. Efficient use of general office equipment required.
  • Excellent communication skills, both written and verbal.
  • Ability to interact professionally with co-workers, providers, clients, brokers and management-level staff.
  • Excellent phone manner and ability to handle multiple phone lines.
  • Ability to answer questions independently.
  • Must be able to problem solve.
  • Must be able to meet established deadlines.
  • Attention to details.

 

Preferences

  • BA or BS degree or equivalent with emphasis in Business Administration preferred

Equal Opportunity Employer