Healthcare Operations Specialist (Value-Based Care)

Pay Range: $16.50 – $20.46/hour

Job Overview

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.

Job Summary – Key Highlights

• Support value-based care and Medicare Advantage initiatives across multiple clinics and markets
• Ensure accurate member attribution, payer alignment, and insurance data integrity
• Investigate and resolve attribution, enrollment, and payer-related issues
• Support Medicare enrollment and retention efforts during AEP, OEP, and ROY
• Serve as a knowledgeable insurance resource for clinics and patients
• Maintain accurate data in EHR systems and payer portals
• Collaborate cross-functionally to improve workflows and patient experience

Essential Duties and Responsibilities

Value-Based Care Operations & Attribution

• 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

Enrollment, Retention & Patient Experience

• 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

Collaboration & Communication

• 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

Qualifications:

KNOWLEDGE/SKILLS/ABILITIES:

• 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

EDUCATION AND EXPERIENCE REQUIREMENTS

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

Salary : $17 - $20