Job Description :
This job is a key member of the Helion Network Communications and Network Operations Team taking on a significant role for complex operational aspects of provider communications/educations, Helion Help Desk management and supportive functions related to network development and reimbursement programs. This includes knowledge of networks and contract structures relative to current and proposed future state through the lens of the overall Helion post-acute network strategy. This role will also serve Helion as a subject matter expert on contract terms, including payment provisions for value-based arrangements across multiple business lines, including Commercial and Government Programs. In addition, this role will be responsible for taking a significant operational/implementation role for new reimbursement and evidenced based programming. This role will work across the matrix to partner with key functions, including contract administration, provider contracting, legal, compliance, provider audit, and other key implementation stakeholders, and support multiple health plan clients. This role will be the primary lead for Helion Help Desk and lead the day-to-day operations of interactions with providers, communication with internal teams and maintaining the expected turnaround times for inquiry resolution. This role will frequently integrate with providers and customers and needs to have excellent communication and customer service skills.
- Source and act as subject matter expert (SME) on post-acute provider contracts across all client markets and geographies. Understand payment and other contractual provisions and how those align to the Helion network and reimbursement strategy and roadmap.
- Survey provider landscape across geographies, including direct research and geo access/capacity modeling, to understand where network development may be needed and take a lead role for communication and development activities.
- Serve as liaison to Helion Network Performance team as SME for complex operational inquires and interact with providers to share knowledge, answer questions, or obtain needed documents and insights when requested.
- Understand the differences among contracts between multiple clients and geographies.
- Work cross-functionally to play a lead facilitator role in education and supporting implementation of reimbursement and evidenced based programs to the network providers.
- Work across the matrix to support provider inquiries, concerns, or questions.
- Other duties as assigned or requested.
- Bachelor's Degree in Business, Finance, Information Management, Healthcare Administration or Health Related Discipline
6 years of relevant and progressive experience in lieu of Bachelor degree
- 5 years in Health Care Administration, Contract Management, Network Development, Finance or a related field
- 7 years in Health Care Administration, Contract Management, Network Development, Finance or a related field
- 5 years in Business Analysis, Economic Modeling or a related field
LICENSES or CERTIFICATIONS
- Provider Reimbursement
- Microsoft Word, Excel and PowerPoint
- Outstanding Interpersonal Communication Skills
- Oral & Written Communication Skills
- Teamwork and Collaboration
- Business Analysis
Language: (Other than English)
0% - 25%
PHYSICAL, MENTAL DEMANDS and WORKING CONDITIONS
Teaches / trains others regularly
Travel regularly from the office to various work sites or from site-to-site
Works primarily out-of-the office selling products/services (sales employees)
Physical work site required
Lifting: up to 10 pounds
Lifting: 10 to 25 pounds
Lifting: 25 to 50 pounds
Disclaimer: The job description has been designed to indicate the general nature and essential duties and responsibilities of work performed by employees within this job title. It may not contain a comprehensive inventory of all duties, responsibilities, and qualifications required of employees to do this job.
Compliance Requirement : This job adheres to the ethical and legal standards and behavioral expectations as set forth in the code of business conduct and company policies.
As a component of job responsibilities, employees may have access to covered information, cardholder data, or other confidential customer information that must be protected at all times. In connection with this, all employees must comply with both the Health Insurance Portability Accountability Act of 1996 (HIPAA) as described in the Notice of Privacy Practices and Privacy Policies and Procedures as well as all data security guidelines established within the Company’s Handbook of Privacy Policies and Practices and Information Security Policy.
Furthermore, it is every employee’s responsibility to comply with the company’s Code of Business Conduct. This includes but is not limited to adherence to applicable federal and state laws, rules, and regulations as well as company policies and training requirements.
Highmark Health and its affiliates prohibit discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities, and prohibit discrimination against all individuals based on their race, color, religion, sex, national origin, sexual orientation/gender identity or any other category protected by applicable federal, state or local law. Highmark Health and its affiliates take affirmative action to employ and advance in employment individuals without regard to race, color, religion, sex, national origin, sexual orientation/gender identity, protected veteran status or disability.
Highmark Health and its affiliates prohibit discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities, and prohibit discrimination against all individuals based on their race, color, age, religion, sex, national origin, sexual orientation/gender identity or any other category protected by applicable federal, state or local law. Highmark Health and its affiliates take affirmative action to employ and advance in employment individuals without regard to race, color, age, religion, sex, national origin, sexual orientation/gender identity, protected veteran status or disability.
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