Payor Operations Specialist

Job Type: Regular

Time Type: Full time

Work Shift: Day (United States of America)

FLSA Status: Exempt

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.

Job Description:

Essential Duties & Responsibilities including but not limited to:

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

Organizational Requirements:

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.

Minimum Qualifications:

Education: A Bachelor’s Degree in Healthcare Management, Administration, Public Health, Business Administration, or other related functional area is required.

Licensure, Certification & Registration: N/A

Experience: 1-3 years of experience with Payor relationships, contract elements within value based care, or other related field within a healthcare environment required. Experience with strategy and opportunity evaluation a plus. · 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. Director provides broad guidance and overall direction. · 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

Skills, Knowledge & Abilities: Microsoft Word, Excel, Powerpoint, SmartSheet (preferred)

Key Relationships:

1 BILHPN Ops Teams

2 BILHPN Clinical Excellence Teams

3 Local Care Unit Leaders .

4 Vendor Contacts (as applicable)

5 Practice/Local Care Unit Staff

6 Providers

7 HMFP Leaders

8 BILH Revenue Cycle

9 APG Leaders

10 BILHPC Leaders

11 Care Retention & Access Leaders

Scope/Impact Statement:

Work Schedule: Indicate either Yes or No as appropriate. Hours of work may be subject to change based upon the needs of the business/department.

On Call: No Shift Rotation: No Weekends: No

Physical Requirements & Environment: Required

For each category, select ONE option from choices below by placing an X in the space to the left of the entry.

Mental and Visual Attention Required

a) The position requires basic mental and visual attention much or all of the time

b) X The position requires periods of concentrated mental and visual attention.

c) The position requires a high degree of mental and visual concentration.

Physical Exertion

Weight

d) X Nature of work requires lifting or moving light weight (up to 20 pounds).

e) Nature of work requires lifting or moving medium weight (over 20 and up to 75 pounds).

f) Nature of work requires lifting or moving heavy weight (over 75 pounds).

Dexterity

g) X Flow of work and character of duties require average manual coordination.

h) Flow of work and character of duties require above average manual coordination.

i) Flow of work and character of duties require high manual coordination.

Range of Motion

j) X Duties require average range of motion.

k) Duties require above average range of motion.

l) Duties require high range of motion.

Physical Conditions

m) Performance of duties allows for variation in positioning and tasks.

n) X Performance of duties requires remaining in position for prolonged periods of time.

Repetitive Motion

o) Assignments require occasional repetitive motion.

p) X Assignments require frequent repetitive motion.

q) Assignments require constant repetitive motion.

Working Conditions

r) X Working conditions include minimal exposure to elements such as odor, noise, dust, chemicals, temperature extremes or airborne pathogens.

s) Working conditions include occasional exposure to elements such as odor, noise, dust, chemicals, temperature extremes or airborne pathogens.

t) Working conditions include continuous exposure to elements such as odor, noise, dust, chemicals, temperature extremes or airborne pathogens.

Exposure to Hazardous Materials

u) X Performance of duties generally does not involve exposure to hazardous materials.

v) Performance of duties occasionally involves exposure to hazardous materials.

w) Performance of duties frequently involves exposure to hazardous materials.

Patient Care Conditions (select ALL that are applicable)

x) Position entails exposure to blood and body fluids, standard precautions must be used.

y) Assignments include transporting, transfer and positioning of patients.

z) Incumbent must be continuously prepared to prevent a patient fall.

Sensory Requirements (select ALL that are applicable)

aa) Performance of duties requires the ability to discern and identify colors

bb) Performance of duties requires the ability to discern sharp from dull and hot from cold

cc) Performance of duties requires the ability to hear soft and loud noises

Patient Care/Patient Contact Designation (check only one of the items listed below)

_ Position has a direct impact upon health outcomes of the patient.

_ Position facilitates the process that may impact patient access to services.

X No patient care/contact, and does not facilitate the patient care process or directly impact health outcomes.

This Job Description is intended to describe the general nature and level of work being performed by people assigned to this classification. It is not intended to be construed as an exhaustive list of all responsibilities, requirements, duties and skills required of personnel so classified. Additional duties and responsibilities that are specific to the Department or Unit are identified and maintained by the Manager as an Addendum to the Job Description.

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. Learn more about this requirement.

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