What are the responsibilities and job description for the Healthcare Operations Coordinator position at Point32Health?
Job Description
The Healthcare Operations Coordinator assists with all operational aspects of the Member Appeals and Grievances process for Commercial, TMP, and Public Plans products. This position requires a strong understanding of regulatory requirements and timeframes, as well as the ability to handle each function appropriately and prioritize tasks. The successful candidate will be able to work independently but also identify when they should ask for help. Additionally, flexibility to respond to changing needs in the Department is essential.
Responsibilities
- Assist with distribution and classification of cases in compliance with applicable timeframes and regulations.
- Gather information on behalf of specialists with external vendors.
- Coordinate requests for medical records and track effectuations.
- Facilitate delivery of appeals and related information to key departments and appeals committee members.
- Analyze and report data regarding department processes as requested from management.
Requirements
- BA/BS or equivalent in healthcare, administrative, or related field preferred.
- 1-2 years of experience in a healthcare and/or administrative setting preferred.
- Must have computer skills with experience in EXCEL and WORD. Must have knowledge and demonstrated ability in the use of Windows applications and other comparable systems/applications. Knowledge of basic medical terminology a plus.
Benefits
- Medical, dental, and vision coverage.
- Retirement plans.
- Employer-paid life and disability insurance with additional buy-up coverage options.
- Full suite of benefits to support career development, individual & family health, and financial health.
About Us
At Point32Health, we are dedicated to delivering an ever-better personalized healthcare experience to everyone in our communities. We build on the quality, nonprofit heritage of our founding organizations, Tufts Health Plan and Harvard Pilgrim Health Care.
The Healthcare Operations Coordinator assists with all operational aspects of the Member Appeals and Grievances process for Commercial, TMP, and Public Plans products. This position requires a strong understanding of regulatory requirements and timeframes, as well as the ability to handle each function appropriately and prioritize tasks. The successful candidate will be able to work independently but also identify when they should ask for help. Additionally, flexibility to respond to changing needs in the Department is essential.
Responsibilities
- Assist with distribution and classification of cases in compliance with applicable timeframes and regulations.
- Gather information on behalf of specialists with external vendors.
- Coordinate requests for medical records and track effectuations.
- Facilitate delivery of appeals and related information to key departments and appeals committee members.
- Analyze and report data regarding department processes as requested from management.
Requirements
- BA/BS or equivalent in healthcare, administrative, or related field preferred.
- 1-2 years of experience in a healthcare and/or administrative setting preferred.
- Must have computer skills with experience in EXCEL and WORD. Must have knowledge and demonstrated ability in the use of Windows applications and other comparable systems/applications. Knowledge of basic medical terminology a plus.
Benefits
- Medical, dental, and vision coverage.
- Retirement plans.
- Employer-paid life and disability insurance with additional buy-up coverage options.
- Full suite of benefits to support career development, individual & family health, and financial health.
About Us
At Point32Health, we are dedicated to delivering an ever-better personalized healthcare experience to everyone in our communities. We build on the quality, nonprofit heritage of our founding organizations, Tufts Health Plan and Harvard Pilgrim Health Care.
