Health Plan Communication Liaison
Job DescriptionPosition
Summary:
The Health Plan Communication Liaison manages the relationship with assigned health plans, and keeps smooth communication and interaction with the health plans and business units in RMG/LMG/ADOC Medical Groups.
The Health Plan Communication Liaison is accountable for establishing positive and effective working relationships with designees from each health plan and assuring that the delegated responsibilities are successfully represented to the health plan within regulatory compliance.
Essential Duties and Responsibilities include the following:
Establish relationships with health plan contacts interface with Health Plans on any aspects of compliance requirements Understand the underlying regulatory and delegated requirements, develops deep understanding of data and related business processes Prepare Health Plan reports, workplans, identify and correct data issues prior to submission, submits reports in a compliance and timely manner.
Analyze data and utilize other internal reporting to - identify compliance issues, and work with business owners on development of internal corrective action plans Prepares for audits, represents groups at audits and drive onsite and desktop audits.
Prepare and complete work plans for the assigned health plans Works collaboratively with business units on identifying and closing compliance gaps and CAPs.
Work collaboratively with the Quality Monitoring team to track the effectiveness of corrective actions.
Keep abreast with changes in legislation to act as a subject matter expert to the business.
Identifies policies/procedures and processes needing modification to meet new requirements or remediate gaps in compliance Interface with HPN and compliance department to achieve optimal results Maintains and tracks accurate and detailed documentation on requests and submission, and posts on department drive.
Works in a HIPPA compliant and timely manner.
Works with a high degree of independence, while seeking guidance when necessary and escalates issues to his/her immediate supervisor as needed.
Proactively Identifies and escalates potential compliance issues Maintain up to date departmental grids/dashboards/tools as required.
All other duties as directed by management.
The pay range for this position at commencement of employment is expected to be between $25 - $27 per hour; however, base pay offered may vary depending on multiple individualized factors, including market location, job-related knowledge, licensure, skills, and experience.
The total compensation package for this position may also include other elements, including a sign-on bonus and discretionary awards in addition to a full range of medical, financial, and/or other benefits (including 401(k) eligibility and various paid time off benefits, such as vacation, sick time, and parental leave), dependent on the position offered.
Details of participation in these benefit plans will be provided if an employee receives an offer of employment.
If hired, employee will be in an at-will position and the Company reserves the right to modify base salary (as well as any other discretionary payment or compensation program) at any time, including for reasons related to individual performance, Company or individual department/team performance, and market factors.
As one of the fastest growing Independent Physician Associations in Southern California, Regal Medical Group, Lakeside Community Healthcare Affiliated Doctors of Orange County, offers a fast-paced, exciting, welcoming and supportive work environment.
Opportunities abound, and enterprising, capable, focused people prosper with us.
We promote teamwork, nurture learning, and encourage advancement for all of our employees.
We want to see you excel, because we believe that your success is our success.
Full Time Position
Benefits:
The success of any company depends on its employees.
For us, employee satisfaction is crucial not only to the well-being of our organization, but also to the health and wellness of our members.
As such, we are firmly dedicated to providing our employees the options and resources necessary for building security and maintaining a healthy balance between work and life.
Our dedication to our staff is evident in our comprehensive benefits package.
We offer a very generous mixture of benefits, including many employer-paid options.
Health and Wellness:
Employer-paid comprehensive medical, pharmacy, and dental for employees Vision insurance Zero co-payments for employed physician office visits Flexible Spending Account (FSA) Employer-Paid Life Insurance Employee Assistance Program (EAP) Behavioral Health Services Savings and Retirement:
401k Retirement Savings Plan Income Protection Insurance Other
Benefits:
Vacation Time Company celebrations Employee Assistance Program Employee Referral Bonus Tuition Reimbursement License Renewal CEU Cost Reimbursement Program Business-casual working environment Sick days Paid holidays Mileage Employer will consider for employment qualified applicants with criminal histories in a manner consistent with the requirements of the LA City Fair Chance Initiative for Hiring Ordinance.
RequirementsEducation and/or
Experience:
4 years University graduate required.
Health Care Administration degree preferred.
Minimum of two years of prior experience in healthcare environment required.
Minimum 1 2 year Data analysis or project management experience preferred.
Must have excellent communications skills both verbally and written.
Highly Proficient in MS Office programs (i.
e.
, Word, Excel, Outlook, Access and Power Point) required.
Strong working knowledge of Excel, tables and pivot tables.
Ability to deal with responsibility with confidential matters.
Must have strong organization skills.
Ability to work in a multi-task, high stress environment.
Must be able to handle multiple projects at one time, reset priorities day-to-day to meet deadlines, and know when to ask for assistance and direction when working with conflicting priorities.
Must be self-motivated, pleasantly aggressive and realistically ambitious and have high personal ethics.
Must have the ability to work with all levels of management and have the ability to develop positive working relationships with health plan auditors and company department heads.
Recommended Skills Auditing Business Processes Communication Coordinating Dashboard Data Analysis Estimated Salary: $20 to $28 per hour based on qualifications.
Summary:
The Health Plan Communication Liaison manages the relationship with assigned health plans, and keeps smooth communication and interaction with the health plans and business units in RMG/LMG/ADOC Medical Groups.
The Health Plan Communication Liaison is accountable for establishing positive and effective working relationships with designees from each health plan and assuring that the delegated responsibilities are successfully represented to the health plan within regulatory compliance.
Essential Duties and Responsibilities include the following:
Establish relationships with health plan contacts interface with Health Plans on any aspects of compliance requirements Understand the underlying regulatory and delegated requirements, develops deep understanding of data and related business processes Prepare Health Plan reports, workplans, identify and correct data issues prior to submission, submits reports in a compliance and timely manner.
Analyze data and utilize other internal reporting to - identify compliance issues, and work with business owners on development of internal corrective action plans Prepares for audits, represents groups at audits and drive onsite and desktop audits.
Prepare and complete work plans for the assigned health plans Works collaboratively with business units on identifying and closing compliance gaps and CAPs.
Work collaboratively with the Quality Monitoring team to track the effectiveness of corrective actions.
Keep abreast with changes in legislation to act as a subject matter expert to the business.
Identifies policies/procedures and processes needing modification to meet new requirements or remediate gaps in compliance Interface with HPN and compliance department to achieve optimal results Maintains and tracks accurate and detailed documentation on requests and submission, and posts on department drive.
Works in a HIPPA compliant and timely manner.
Works with a high degree of independence, while seeking guidance when necessary and escalates issues to his/her immediate supervisor as needed.
Proactively Identifies and escalates potential compliance issues Maintain up to date departmental grids/dashboards/tools as required.
All other duties as directed by management.
The pay range for this position at commencement of employment is expected to be between $25 - $27 per hour; however, base pay offered may vary depending on multiple individualized factors, including market location, job-related knowledge, licensure, skills, and experience.
The total compensation package for this position may also include other elements, including a sign-on bonus and discretionary awards in addition to a full range of medical, financial, and/or other benefits (including 401(k) eligibility and various paid time off benefits, such as vacation, sick time, and parental leave), dependent on the position offered.
Details of participation in these benefit plans will be provided if an employee receives an offer of employment.
If hired, employee will be in an at-will position and the Company reserves the right to modify base salary (as well as any other discretionary payment or compensation program) at any time, including for reasons related to individual performance, Company or individual department/team performance, and market factors.
As one of the fastest growing Independent Physician Associations in Southern California, Regal Medical Group, Lakeside Community Healthcare Affiliated Doctors of Orange County, offers a fast-paced, exciting, welcoming and supportive work environment.
Opportunities abound, and enterprising, capable, focused people prosper with us.
We promote teamwork, nurture learning, and encourage advancement for all of our employees.
We want to see you excel, because we believe that your success is our success.
Full Time Position
Benefits:
The success of any company depends on its employees.
For us, employee satisfaction is crucial not only to the well-being of our organization, but also to the health and wellness of our members.
As such, we are firmly dedicated to providing our employees the options and resources necessary for building security and maintaining a healthy balance between work and life.
Our dedication to our staff is evident in our comprehensive benefits package.
We offer a very generous mixture of benefits, including many employer-paid options.
Health and Wellness:
Employer-paid comprehensive medical, pharmacy, and dental for employees Vision insurance Zero co-payments for employed physician office visits Flexible Spending Account (FSA) Employer-Paid Life Insurance Employee Assistance Program (EAP) Behavioral Health Services Savings and Retirement:
401k Retirement Savings Plan Income Protection Insurance Other
Benefits:
Vacation Time Company celebrations Employee Assistance Program Employee Referral Bonus Tuition Reimbursement License Renewal CEU Cost Reimbursement Program Business-casual working environment Sick days Paid holidays Mileage Employer will consider for employment qualified applicants with criminal histories in a manner consistent with the requirements of the LA City Fair Chance Initiative for Hiring Ordinance.
RequirementsEducation and/or
Experience:
4 years University graduate required.
Health Care Administration degree preferred.
Minimum of two years of prior experience in healthcare environment required.
Minimum 1 2 year Data analysis or project management experience preferred.
Must have excellent communications skills both verbally and written.
Highly Proficient in MS Office programs (i.
e.
, Word, Excel, Outlook, Access and Power Point) required.
Strong working knowledge of Excel, tables and pivot tables.
Ability to deal with responsibility with confidential matters.
Must have strong organization skills.
Ability to work in a multi-task, high stress environment.
Must be able to handle multiple projects at one time, reset priorities day-to-day to meet deadlines, and know when to ask for assistance and direction when working with conflicting priorities.
Must be self-motivated, pleasantly aggressive and realistically ambitious and have high personal ethics.
Must have the ability to work with all levels of management and have the ability to develop positive working relationships with health plan auditors and company department heads.
Recommended Skills Auditing Business Processes Communication Coordinating Dashboard Data Analysis Estimated Salary: $20 to $28 per hour based on qualifications.
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