Health Plans Specialist Job at Adventist Health Tillamook
Adventist Health is more than an award-winning health system. We provide whole-person care to our communities and champion the greater good - from the operating room to the boardroom, we are driven by our unique passion to live God's love through health, wholeness and hope. From Oregon to Oahu, we have a calling to always do more. Now is your chance to apply your passion to our mission.
We're looking for someone to join our team as a Health Plans Specialist who:
Provides leadership and support in maintaining compliance with organization's contracted health plans.
Essential Functions:
- Acts as liaison between organization, providers, provider groups and various health plan representatives. Participates in the planning, development, and implementation of the organization provider relations and health plan policies, procedures and processes.
- Identifies and resolves problems relating to the health plans and Providers using effective verbal and written communication in the context of excellent customer service. Provides excellent customer service via phone calls, in-person visits, letters and various forms of electronic communication.
- Collaborates with leadership to evaluate trends, identify preferred practice patterns and provide further education to providers on health plan initiatives and expectations. Interfaces with all levels of the organization in order to ensure provider data accuracy. Assists in facilitating initial/re-credentialing activities.
- Provides support to achieve improved effectiveness and efficiencies in the organizational operational process. Attends and participates in various health plan meetings, and committees as assigned.
- Performs other job-related duties as assigned.
You'll be successful with the following qualifications:
Education:
- Associate's / Technical Degree or equivalent combination of education/related experience: Required
- Bachelor's degree: Preferred
Work Experience:
- Five years experience in the healthcare industry: Preferred
Adventist Health is committed to the safety and wellbeing of our associates and patients. Therefore, we require that all associates receive all required vaccinations, including, but not limited to, measles, mumps, flu (based on the seasonal availability of the flu vaccine typically during October-March each year), COVID-19 vaccine (required in CA, HI and OR) etc., as a condition of employment, and annually thereafter. Medical and religious exemptions may apply.
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