BCBS HMO Coordinator

Overview Job Title: BCBS HMO Coordinator... Location: Flexible (Remote options available) Company Overview: At Duly Health and Care, we're dedicated to revolutionizing healthcare delivery through innovative solutions and collaborative partnerships. As a leading provider in the industry, we strive to empower individuals and communities to achieve optimal health outcomes. Join us in our mission to make a meaningful difference in the lives of millions. We are seeking a dynamic and detail-oriented BCBS HMO Coordinator to join our Payor Contracting/MA Management team. In this role, you will serve as the linchpin between our HMO Payor Contracting division and internal Duly operations areas. Your expertise and proactive approach will be instrumental in fostering seamless communication, resolving issues, and optimizing operational efficiency. Responsibilities Key Responsibilities: ? Act as the primary liaison between payors and internal Duly operations, ensuring effective communication and collaboration. ? Coordinate responses to payor issues under the guidance of the Director of MA, facilitating timely resolution and follow-up. ? Collaborate with cross-functional teams to address payor-related Claims, Utilization Management, and Quality issues, driving towards optimal solutions. ? Conduct ad-hoc analysis and reporting to support delegated payor operations, leveraging data insights to inform strategic decision-making. ? Prepare and track monthly, quarterly, and annual submissions related to delegated payor operations, maintaining meticulous records. ? Stay informed about payor updates, changes, and industry trends, disseminating pertinent information to operational areas. ? Facilitate and manage payor meetings, including agenda preparation, documentation, and follow-up actions. ? Maintain provider directory submissions in alignment with delegated payor criteria, ensuring accuracy and compliance. ? Oversee the resolution of Payor complaints and PCP letter requests, upholding a high standard of customer service. ? Supervise and coordinate the yearly UM Fund Challenges process and MA reconciliation process, driving accountability and efficiency. ? Undertake additional duties and projects as assigned by management, demonstrating flexibility and adaptability. Qualifications Qualifications: ? Bachelor's degree in a related field preferred. ? 2-3 years of experience in payor contracting, payor operations, or a similar role within the healthcare industry. ? Strong organizational and time management skills, with a keen attention to detail. ? Excellent written and verbal communication abilities, with proficiency in Microsoft Office Suite. ? Analytical mindset with the ability to interpret and analyze data effectively. ? Knowledge of healthcare industry dynamics and payor operations. ? Familiarity with project management principles and practices. ? Ability to work independently and collaboratively in a fast-paced, team-oriented environment. ? Strong problem-solving skills and a commitment to maintaining professionalism and confidentiality. Why Join Us: ? Opportunity to make a tangible impact in the healthcare industry and contribute to meaningful change. ? Competitive compensation package with comprehensive benefits and remote work options. ? Collaborative and supportive team environment that values innovation and continuous learning. ? Growth and development opportunities to expand your skills and advance your career. ? Join a mission-driven organization committed to improving healthcare outcomes and enhancing the patient experience

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