This job listing has expired and the position may no longer be open for hire.

Pools Coordinator I/II - 005680 at Excellus

Posted in General Business 30+ days ago.

Type: Full-Time
Location: De Witt, New York





Job Description:

Under the leadership of the Assigned Management and in accordance with established objectives, assists with the coordination of the workflow and training needs for the team. Responsible for problem solving as it relates to Third Party Administrator (TPA), Payor, and Provider reporting and election processing. Maintains professional communication with payors, TPA's and Providers on issues related to their reporting and election processing. Ensures the accuracy and timely distribution of TPA, Payor and Provider delinquency notices.

Essential Responsibilities/Accountabilities

All Levels


  • Liaison between TPA's, Payors, Providers and the New York State Department of Health (DOH) on matters that include monthly and annual reporting, delinquency and election status.
  • Investigates and resolves TPA/ Payor problems with election and payment issues.
  • Provides guidance to customers on access to and use of our web portal.
  • Assists support staff and management as necessary in the review and processing of incoming and outgoing correspondence.
  • Assists in the preparation of materials for the annual audit of the department, including direct interaction with outside auditors and NYSDOH personnel as it relates to HCRA Compliance Audits.
  • Assists other Pool staff and management in the timely and accurate processing of all cash receipts and disbursements. Identifies, and assists with, the resolution of any problems that may arise.
  • Consistently demonstrates high standards of integrity by supporting the Lifetime Healthcare Companies' mission and values and adhering to the Corporate Code of Conduct and leading to the Lifetime Way values and beliefs.
  • Maintains high regard for member privacy in accordance with the corporate privacy policies and procedures.
  • Regular and reliable attendance is expected and required.
  • Performs other functions as assigned by management

Level II - in addition to the Level I responsibilities:

  • Assists with quality improvement and ongoing quality assurance efforts including, but not limited to, peer review and feedback to management. Must be able to initiate quality improvement suggestions.
  • Assists in the establishment and maintenance of policies and procedures and makes recommendations to management as to process improvements and efficiencies.
  • Assists with testing of new or enhanced database and/or web applications.
  • Assists in the training of staff on processes as they relate to Provider, TPA, and Payor reporting.
  • Assists management and DOH with the establishment of procedures related to the assessment of penalty and interest and will carry out this initiative through communication with DOH, management, TPA's, Payors, and Providers.

Minimum Qualifications

Note of Classification

We include multiple levels of classification differentiated by demonstrated knowledge, skills, and the ability to manage increasingly independent and/or complex assignments, broader responsibility, additional decision making, and in some cases, becoming a resource to others. In addition to using this differentiated approach to place new hires, it also provides guideposts for employee development and promotional opportunities.

All Levels


  • Associate's degree in Business Administration or related field with a minimum of three years of experience in Business Administration, operations, or other customer satisfaction background. In lieu of degree, a minimum of six years or experience in Business Administration, operations, or other customer satisfaction background.
  • Proficiency with personal computers, including Microsoft Excel and Word as well as understanding database systems and web applications.
  • Excellent and diplomatic communication skills including oral, written, and listening.
  • Detailed knowledge and understanding of Part 86-1 of the Commissioner of Health's Administrative Rules and Regulations relating to pools, including the Health Care Reform Act of 1996 & 2000 and subsequent legislation.
  • Above average organizational, reasoning, and problem-solving skills.
  • Demonstrates a strong understanding of the business requirements and responsibility for communicating this knowledge professionally and accurately with TPA's, payors, and the New York State Department of Health (DOH) on matters that include monthly and annual reporting, delinquency and election status.
  • Must be able to prioritize assignments, work accurately, independently and within established time frames. Will typically be required to multitask while working on several projects simultaneously.
  • Maintains an understanding of electronic filing applications, including the ability to resolve payor problems with election and payment issues. Will provide testing of new or enhanced database and/or web applications.

Level II - in addition to Level I requirements:

  • Associate's degree in Business Administration or related field with a minimum of five years of experience in Business Administration, operations, or other customer satisfaction background. In lieu of degree, a minimum of eight years or experience in Business Administration, operations, or other customer satisfaction background.

Physical Requirements

  • Must be able to function for long periods of time sitting at a desk using a keyboard and/or telephone.
  • May use a headset to listen to customer conversations.

************

The Lifetime Healthcare Companies aims to attract the best talent from diverse socioeconomic, cultural and experiential backgrounds, to diversify our workforce and best reflect the communities we serve.

Our mission is to foster an environment where diversity and inclusion are explicitly recognized as fundamental parts of our organizational culture. We believe that diversity of thought and background drives innovation which enables us to provide leading-edge healthcare insurance and services. With that mission in mind, we recruit the best candidates from all communities, to diversify and strengthen our workforce.

OUR COMPANY CULTURE:

Employees are united by our Lifetime Way Values & Behaviors that include compassion, pride, excellence, innovation and having fun! We aim to be an employer of choice by valuing workforce diversity, innovative thinking, employee development, and by offering competitive compensation and benefits.

In support of the Americans with Disabilities Act, this job description lists only those responsibilities and qualifications deemed essential to the position.

Equal Opportunity Employer





More jobs in De Witt, New York


Best Buy

Best Buy

Best Buy
More jobs in General Business


Gregory Poole Equipment Company

COMMUNITY TRUST BANK INC

Chimes Metro, Inc.