Under the direction of the Manager, Contract Implementation the Lehigh/Capital Operational Coordinator will be responsible for ensuring that the Plan stays in compliance with each of the provider contracts, which govern the relationship between AMHP and its providers in the Lehigh/Capital Area. Specifically, the Lehigh/Capital Operational Coordinator will develop and manage work plans, which track key relationship issues. The Lehigh/Capital Operational Coordinator will ensure that operational issues are being worked and resolved in a timely manner through the Plan. Lehigh/Capital Operational Coordinator will also be responsible for coordinating the Operational meetings set up between the (Corporate) Philadelphia and (Local) Harrisburg offices to resolve claims and other issues. The incumbent will also be responsible for successfully addressing correcting key facility and health system concerns.
Oversees that operational issues are being worked and resolved in a timely manner throughout the Plan.This will require regular communication (written and verbal) and facilitation with various departments, to create a multi-disciplinary approach to include management staff as well as representatives from:Claims, Government Affairs, Configuration, Recoveries, Corporate Financial Investigations, and Provider Maintenance.
Act as the resource to other departments by developing and managing work plans which document the status of key relationship issues and action items for all high profile providers.
Facilitate and Chair weekly Operational meetings
Work with multi-disciplinary team of Operations, Provider maintenance, and Configuration staff to analyze and reconcile issues related to AmeriHealth Mercy Health Plan providers.
Provide all documentation necessary to Provider Contracting and Senior Management on the status and progress of identified provider configuration and workflow issues.
Improve and maintain tracking system of operational issues, progress and status.
The Lehigh/Capital Operational Coordinator will prepare reports outlining the operational status of all high-profile providers which is distributed and reviewed by staff, management, and Senior. Management.
The Lehigh/Capital Operational Coordinator will work to streamline, and reduce total turn-around times with Provider Maintenance and Facets Administration to eliminate bottlenecks and provider set up issues and increase provider satisfaction by reducing the end-to-end timeframe for project resolution whenever possible.
Take a lead role in building contract management issue resolution by working with the Corporate multi-disciplinary team of Operations members.
Serves as a resource to Provider Contracting Representatives, providing direction where appropriate.
The Lehigh/Capital Operational Coordinator will assist Provider Contracting Representatives as necessary to assess issues/problems being encountered by providers and staff.
The Lehigh/Capital Operational Coordinator will serve as a liaison to Philadelphia Operations staff for the Provider Contracting Representatives.
Cooperates with others to achieve departmental goals, interdepartmental relations, and public relations.
Performs other related duties as assigned by Manager, Contract Implementation.
Assists Manager with special projects and promotions
Joins and participates in applicable professional organizations
Attends required training on an annual basis.
Performs other related duties and projects as assigned
Adheres to established guidelines with respect to absence/lateness as defined by company policy.
Adheres to AMHP policies and procedures.
Bachelor's Degree in Healthcare or related field or extensive equivalent work experience required.
Valid driver's license and access to an automobile/ with current automobile insurance.
3-5 years experience in an HMO, Provider Relations or Configuration or claims resolution setting required. Investigative, decision making problem solving, interpersonal, organizational and analytical skills required.
Amerihealth Caritas Health Plan