operations coordinator Remote
Job description
About the Company:
Avalon Healthcare Solutions, headquartered in Tampa, Florida, is the world’s first and only Lab Insights company, bringing together our proven Lab Benefit Management solutions, lab science expertise, digitized lab values, and proprietary analytics to help healthcare insurers proactively inform appropriate care, reduce costs, and improve clinical outcomes. Working with health plans across the country, the company covers more than 36 million lives and delivers 7-12% outpatient lab benefit savings. Avalon is pioneering a new era of value-driven care with its Lab Insights Platform that captures, digitizes, and analyzes lab results in real time to provide actionable insights for earlier disease detection, ensuring appropriate treatment protocols, and driving down overall cost.
Studies show that 30% of clinical laboratory testing is unnecessary or overused. Inappropriate testing or missing a key screening can lead to complications and expense arising from unwarranted care, or not obtaining proper care when needed, leading to increased health risks and costs. Avalon helps ensure delivery of the right test, at the right time, and in the right setting. We seek to ensure the most effective patient treatment, improve clinical outcomes, and optimize cost and affordability.
Avalon is a portfolio company of Francisco Partners, a global private equity firm that specializes in investments in technology and technology-enabled service companies.
Avalon is a high growth company where every associate has an opportunity to make a difference. You will be part of a team that shapes a new market and business. Most importantly, you will help Avalon to achieve its mission and improve clinical outcomes and health care affordability for the people we serve.
For more information about Avalon, please visit www.avalonhcs.com.
Avalon Healthcare Solutions is proud to be an equal opportunity employer including disability/veteran. We are committed to equal employment opportunity regardless of race, color, ancestry, religion, sex, national origin, sexual orientation, age, citizenship, marital status, disability, gender identity or Veteran status.
Avalon Healthcare Solutions provides and maintains a drug-free workplace for its employees.
About the Health Savings Account Operations Coordinator Position:
The Health Savings Account Operations Coordinator will assist in the direct oversight and management of the Avalon network of contracted providers. Specifically, this position will coordinate with the Operations and Finance department to assure the timely resolution of issues relating to the providers’ experience in the Avalon model. In addition, this position will investigate claims and relay relevant claims processing information to Providers and resolve their issues. This position will collaborate with the Finance department with researching member deductibles in accordance with Avalon’s outlined Health Saving Account process. This function may include re-education of the provider with respect to Avalon’s policies and procedures, as well as the proper order management necessary for successful claims administration. This position will oversee and manage the metrics and reporting services necessary to effectively administer the laboratory network to meet all client responsibility.
This position is eligible for remote work, but quarterly travel to the corporate office in Tampa, Florida may be required.
Health Savings Account Operations Coordinator – Essential Responsibilities:
- Investigate claims following company work instructions
- Assist providers in navigating avalonhcs.com and client health plan websites and encourage and reassure them to become self-sufficient
- Coordinate with the Operations and Finance department to identify unresolved complaints related to claims management and manage to a resolution
- Collaborate with Avalon clinical and coding experts to advise provider in regards to the efficient application of medical policy in an attempt to align policy and lab order management
- Track all incoming requests by providers for participation in the Avalon network and coordinate responses to the providers under the direction of the Claims Manager
- Coordinate with other departments to identify reporting mechanisms, implement reporting, and disperse same to management
Health Savings Account Operations Coordinator – Minimum Qualifications:
- Bachelor’s Degree preferred
- Minimum 2 years’ experience working in the health insurance industry
- Knowledge of UB/institutional (CMS-1450) and/or professional (CMS-1500) claims
- Demonstrated ability to quickly build rapport and respond to providers by identifying and exceeding their expectations (responding in respectful, timely manner, consistently meeting commitments)
- Demonstrated ability to listen skillfully, collect relevant information, determine immediate requests and identify the current and future needs of the provider
- Proficient solving approach to quickly assess current state and formulate recommendations
- Proficient conflict management skills to include ability to resolve issues in a stressful situation and demonstrating personal resilience
- Customer service experience via telephone
- Understanding of health insurance claims and terminology
- Familiar with health plan contracting
- Experience with account or project coordination
- Proficient written and oral communication skills required
- Proficiency in computer skills including Microsoft Office Suite products
Health Savings Account Operations Coordinator – Preferred Qualifications
- Knowledge of physician practice and hospital coding, billing and medical terminology, CPT, HCPCS, ICD-10
- Exceptional interpersonal skills with demonstrated ability to work independently as well as with a team
- Strong organizational skills
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