Payor Operations Specialist

Payor Operations SpecialistWhen 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.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 contractsLeads Payor deliverable oversight, including tracking and sending of deliverables and facilitation of deliverable needs where applicableDevelop and optimize integration, in collaboration with respective teams, of applicable Payor needs and considerations across BILHPNPerform evaluations and gap analyses regarding Payor requirements to appropriately develop interventions that are needed to support contract requirementsGrow and uphold Payor relationships, including Payor accountability, with Payor partnersNavigate, develop, implement, and maintain – in partnership with Director, Payor Operations - processes on bi-directional communication avenues needed for Payor alerts, notifications, deliverables, or trainingCreate action plans, roadmaps, and business cases for opportunity within the Payor space that needs to be addressed to perform appropriatelyMaintains inventory of Payor deliverablesManages Payor deliverables through the full lifecycle – planning, execution, monitoring, and completionAttends Payor specific meetings, including gathering of and updating materialsSynthesizes and reviews Payor reporting packages to ensure BILHPN stakeholders are receiving what they need, with recommendations being sought through if adjusts are neededRefines current processes related to Payor requirementsAssists with compilation of materials related to Payor requirementsLeads communication efforts with Payor stakeholdersDevelop and maintain strong vendor relationships that support success within contractsProactively support addressing impacts, barriers, and risks to deliverablesCommunicates content information appropriately to stakeholders, local leaders, administrators, support staff, BILHPN teams, and providersBuild 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 areasOrganizational 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 stakeholders. 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/AExperience: 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 needsSkills, Knowledge & Abilities: Microsoft Word, Excel, Powerpoint, SmartSheet (preferred)Key Relationships:1 BILHPN Ops Teams2 BILHPN Clinical Excellence Teams3 Local Care Unit Leaders4 Vendor Contacts (as applicable)5 Practice/Local Care Unit Staff6 Providers7 HMFP Leaders8 BILH Revenue Cycle9 APG Leaders10 BILHPC Leaders11 Care Retention & Access LeadersScope/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: NoPhysical Requirements & Environment: RequiredFor 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 Requireda) The position requires basic mental and visual attention much or all of the timeb) X The position requires periods of concentrated mental and visual attention.c) The position requires a high degree of mental and visual concentration.Physical ExertionWeightd) 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).Dexterityg) 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 Motionj) X Duties require average range of motion.k) Duties require above average range of motion.l) Duties require high range of motion.Physical Conditionsm) 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 Motiono) Assignments require occasional repetitive motion.p) X Assignments require frequent repetitive motion.q) Assignments require constant repetitive motion.Working Conditionsr) 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 Materialsu) 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 colorsbb) Performance of duties requires the ability to discern sharp from dull and hot from cold