Harbor Health
Welcome to Harbor Health, an entirely new multi-specialty clinic group in Austin, TX.
11 - 50
Claims Enrollment Operations Manager
Yesterday
🏡 Remote – New York
Harbor Health
Welcome to Harbor Health, an entirely new multi-specialty clinic group in Austin, TX.
11 - 50
Description
• Responsible for oversight of processing transactional data on behalf of Harbor members. • Assurance of timely and accurate processing of data critical to member and provider satisfaction. • Coordinate development of Operational Reports with TPA and Harbor Health • Identify and coordinate resolution of any issues with appropriate partners • Daily review of Claims and Members processing statuses. • Approval of designated “high dollar” claims. • Track and report on assigned implementation milestones and tasks. • Other duties as assigned.
Requirements
• 7 years of relevant healthcare experience, particularly with regard to health plan operations and technology • Demonstrated success operating high-growth companies • Data analysis skills including the ability to pull data from source systems • Demonstrated creativity in identifying and implementing solutions to complex, ambiguous issues. • Ability to act as a team player • Ability to manage outside vendor relationship • Have the ability to partner in the development, management and operationalizing processes and workflows to maximize efficiencies. • Strong knowledge of state claims/members processing rules and regulations. • Experience implementing and operating delegated TPA, UM, UR, credentialing and related functions • Knowledge of benefit plans design, EOC and other applicable documents. • Experience developing and administering value-based payment arrangements a plus • Masters in Healthcare or Business Administration or other related fields
Apply Now
