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Vendor Liaison - Health Plan Business Operations
Supv LocationINDEPENDENCE
Posting Closes01/22/2018
SupervisorDawn Pardee
Job Code145012
DepartmentCLAIMS QUALITY
  
Job Responsibilities
GEHA is an Equal Opportunity Employer M/F/Disability/Vet, with four locations in the Kansas City metropolitan area. Our company's corporate headquarters is located in Lee's Summit near Douglas Rd and I-470. The claims processing office and call center is located in Independence near Little Blue Parkway and I-70. All offices are easily accessible by freeway from anywhere in the Kansas City metro area.

Open Positions: 1
Location: Independence, MO (Landmark Bldg.)

Summary

Responsible for overseeing Health Plan Business Operations day-to day relationship with current and future external partnerships. Monitors outstanding issues and tracks partner performance. Manages the daily performance of the current and future external partnerships, and works with the current and future external partnerships to help develop their maximum potential Prepares monthly analysis and reviews monthly current and future external partnerships invoices. Provides training for partner staff on new and existing GEHA processes.

Duties

• Serves as company point of contact for issues with GEHA partners within the Health Plan Business Operations division. Acts as a liaison between current and future external partners and GEHA to address issues surrounding contract performance.

• Monitors daily work flow and provides guidance on processes and special handling items.

• Manages the daily performance of the current and future external partnerships. Establishes work priorities for the current and future external partnerships and monitors and reviews the work of the partners. Monitors productivity levels of the partners to ensure company goals are met.

• Maintains current and future external partnerships performance criteria as outlined in the contract and tracks such criteria, against actual performance. Provides external partners performance summary on a monthly basis.

• Evaluates the knowledge and skill levels of the current and future external partnerships staffing to ensure performance levels are meeting and exceeding standards needed to accomplish GEHA’s business requirements

• Prepares analysis to evaluate partner’s contract performance for use in approval of monthly invoices.

• Review the partner’s questionable claims and makes determination concerning payment.

• Maintains records of partners turn-around time to ensure company goals are met.

• Researches and/or answers top priority inquiries.

• Handles grievances and partner relation issues as needed and involves the Director when issues become larger.

• Provides proper training for the current and future external partnerships on new GEHA processes, and any additional training needed on existing processes.

• Monitors current and future external partnerships recruitment to ensure current and future external partnerships has proper staffing for supporting and maintaining GEHA’s business requirements.

• Performs other miscellaneous projects, as assigned.

Education Requirements
Requires three years (90 hours) of college. Additional years of qualifying experience in a claims processing environment at GEHA may be considered in lieu of formal education.

Experience Requirements
Requires five years of online claims processing experience with demonstrated knowledge and skill in leadership, teamwork, collaboration, problem solving and communication including experience in administering training on processes and procedures. Must have a working knowledge of claims processing, medical terminology, medical codes, and reference materials. Must have knowledge of or experience with the following areas: System Configuration, Claims (Medical/Dental), Enrollment, Cost Recovery, Subrogation, and Internal Operations functions. Requires effective verbal and written communication skills necessary to perform supervisory/lead and training duties. Business Analysis experience identifying business needs and determining solutions. Requires project management skills and ability to adapt to plans and priorities to address business needs. Incumbent is required to obtain knowledge of the GEHA Affirmative Action Policy and make decisions regarding promotion and termination of employees that comply with its principles.