(Archived) Correctional Medicine Federal Business Operations Specialist Needed in Nashville, TN

Overview

The Federal Business Operations Specialist will provide support for the Manager, Federal Business Services and the FBOP Division. The role will provide essential support in order to reach divisional objectives and goals as well as coordinating efforts towards the execution of specific projects and efficiencies.

Qualifications

Education:

• Bachelor’s Degree in Health Administration, Business Administration preferred.

Experience:

• 1-2 Years

Licenses/Certifications:

• None required

Responsibilities

• Manage Invoice Queue and matrix report.
• Manage and monitor Denied Claims and IBNR.
• Monitor Do Not Invoice Report for appropriateness.
• Review current provider and prison contract margins to identify areas for improvement.
• Complete quarterly and annual obligations reporting for clients.
• Run ISR/SSR Reports for Network.
• Review and maintain our standard costs used for reporting.
• Complete catastrophic reporting for clients.
• Develop and maintain the process for claim outreach on aging episodes in conjunction with month close outs with clients.
• Establish and maintain good working relationships with internal departments, specialty providers, and clients.
• Review processes, measure performance, communicate results, and offer recommendations in regard to organizational/departmental goals.
• Coordinate internal resources and/or third parties for the execution of projects.
• Ensure projects and tasks are completed timely and within scope per the direction of the manager.
• Monitor CPARs responses and timeliness.
• Process Claims Appeals.
• Back up AMs when needed.
• Maintain and communicate Provider Directory internally
• Excellent Excel Skills (Pivot Tables, large Data manipulation, lookups, sorting, filtering)
• Strong Microsoft office
• Great communication skills, written and verbal
• Basic project management skills
• Execution Skills
• Strong organizational and multitasking skills
• Process driven
• Ability to work across all levels of the organization
• Understanding of basic financial information (Revenue, Expense, Margin, EBITDA, etc.)
• Network provider relations experience and medical claims exposure
• Perform other duties as assigned.

Wellpath is an EOE/Minorities/Females/Vet/Disability Employer