Health Plan Operations Specialist

This position is responsible for ensuring timely and accurate processing and payment of claims by the Third-Party Administrator through competent review of claims adjudication compared to network contracts and current government assigned rates and assists in resolving discrepancies in the claim-authorization process. Located in Asheville, North Carolina, it's services include a Rehabilitation Hospital, Home Health, Outpatient Rehabilitation, Hospice, Palliative Care, Private Duty, PACE (Program of All-inclusive Care for the Elderly) and Orthotics & Prosthetics.

Health Plan Operations Specialist

Experience the HCA Healthcare difference where colleagues are trusted, valued members of our healthcare team. Grow your career with an organization committed to delivering respectful, compassionate care, and where the unique and intrinsic worth of each individual is recognized.

Under general supervision, oversees coordination and analysis of payable claims to outside vendors for services provided to plan participants. This position is responsible for ensuring timely and accurate processing and payment of claims by the Third-Party Administrator through competent review of claims adjudication compared to network contracts and current government assigned rates and assists in resolving discrepancies in the claim-authorization process. Maintains internal and external spreadsheets of government payer and participant payments and receivables, and aids the Finance Manager through back office support required for appropriate data and financial reporting. Also works with contracted, new, and potential network vendors regarding claims processing and payment concerns and appeals as necessary to facilitate the accounts payable process within the plan. Provides financial information data and support required for decision making and process improvement functions of the PACE Leadership Team.

Qualifications

Required Education: Associates Degree. 3 years of directly related work experience in insurance follow-up, billing or collections will be considered in lieu of a degree

Preferred Education: Bachelor's Degree

Required License: None

Required Experience: Minimum of 3 years of directly related work experience in insurance follow-up, billing or collections in a hospital, collection agency or physician office setting. Demonstrated analytical skills required. Experience with Microsoft Word, Excel and Outlook required.

Preferred Experience: Five years working experience in healthcare or health insurance related field

CarePartners, offers a total rewards package that supports the health, life, career and retirement of our colleagues. The available plans and programs include:

• Comprehensive benefits for medical, prescription drug, dental, vision, behavioral health and telemedicine services
• Wellbeing support, including free counseling and referral services
• Time away from work programs for paid time off, paid family leave, long- and short-term disability coverage and leaves of absence
• Savings and retirement resources, including a 401(k) Plan with a 100% match on 3% to 9% of pay (based on years of service), Employee Stock Purchase Plan, flexible spending accounts, preferred banking partnerships, retirement readiness tools, rollover support and financial wellbeing counseling
• Education support through tuition assistance, student loan assistance, certification support, dependent scholarships and a partnership with Galen College of Nursing
• Additional benefits for fertility and family building, adoption assistance, life insurance, supplemental health protection plans, auto and home insurance, legal counseling, identity theft protection and consumer discounts

Learn more about Employee Benefits

Note: Eligibility for benefits may vary by location.

CarePartners Health Services, a member of Mission Health, an operating division of HCA Healthcare, is a healthcare organization serving western North Carolina and offering a full continuum of post-acute care. Located in Asheville, North Carolina, it's services include a Rehabilitation Hospital, Home Health, Outpatient Rehabilitation, Hospice, Palliative Care, Private Duty, PACE (Program of All-inclusive Care for the Elderly) and Orthotics & Prosthetics. With more than 1,200 colleagues and 400 volunteers, CarePartners Health Services is dedicated to helping people of western North Carolina live full and productive lives, despite illness, injury, disability or issues related to aging.

HCA Healthcare has been recognized as one of the World's Most Ethical Companies® by the Ethisphere Institute more than ten times. In recent years, HCA Healthcare spent an estimated 3.7 billion in cost for the delivery of charitable care, uninsured discounts, and other uncompensated expenses.

"There is so much good to do in the world and so many different ways to do it." - Dr. Thomas Frist, Sr. HCA Healthcare Co-Founder

If you find this opportunity compelling, we encourage you to apply for our Health Plan Operations Specialist opening. We promptly review all applications. Highly qualified candidates will be directly contacted by a member of our team. We are interviewing - apply today!

We are an equal opportunity employer. We do not discriminate on the basis of race, religion, color, national origin, gender, sexual orientation, age, marital status, veteran status, or disability status.