Operations Coordinator - Part Time

Description

**This position is open to hybrid work schedule - 1-2x a week onsite**

SUMMARY:

The Operations Coordinator role provides support to the clinical operations team by managing grievances,

capitation deduct reports, facilitation of cap referrals, capitation patient complaints, and various projects as

assigned by leadership.

ESSENTIAL FUNCTIONS:

To perform this job successfully, an individual must be able to perform each essential function satisfactorily with or without accommodation. The requirements listed below are representative, but not all inclusive, of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential job functions.

• Manage the payer grievance mechanism

- Receive payer grievances and concerns and record them.

- Resolve grievances and concerns as appropriate.

- Assign grievances that cannot be resolved to a complaint owner within the operations organization.

- Follow up with grievance owners to ensure complaint resolution is advancing in a timely manner and using a fair process.

- Review / Update grievance information in the database regularly.

- Monitor any resolutions to grievances to ensure they are implemented.

• Manages the completion of capitation deduction (leakage) reports

- Track monthly payments vs. capitation deductions

- Address reasons for capitation deductions

- Make calls to various PCPs, et al, to address the reasons

- Help facilitate necessary referrals

- Review emails and resolve as soon as received (top priority)

• Maintain work progress and timetables communication with direct supervisor
• Communicate effectively with internal and external teams involved in grievance resolution and capitalization deduction processes.
• Maintain strict compliance with State, Federal and other regulations (e.g., OSHA, WC, HIPAA, ADA, FEHA, DOL, HR policies and practices).
• Maintain an appropriate professional appearance and demeanor in accordance with Company policies.
• Other duties as assigned by management.

Requirements

REQUIRED: Minimum 1-3 years of prior experience in a medical office and/or customer service

setting. High School education, GED or equivalent.

DESIRABLE: Associate's degree or higher in a related field. Medical office management

experience. Experience in the Ophthalmic or Optometric Industry. Knowledge of EMR systems.

CERTIFICATES/LICENSES/REGISTRATIONS:

• Valid Driver’s License may be required based on clinic location(s).

KNOWLEDGE/SKILLS/ABILITIES/TALENTS:

• Strong customer service focus
• Knowledge of the basic elements of the business operations.
• Ability to understand, interpret, and apply knowledge of regulatory requirements related to grievances and cap reductions.
• Team player and contributor coupled with excellent communication and interpersonal skills (oral and written).
• Use and knowledge of Microsoft Office Applications (Word, Excel) and use of standard office equipment.
• Ability to respond to common inquiries from customers, staff, vendors, or other members of the community.
• Process Focused (data driven decision-maker; detailed; organized and structured; comprehensive knowledge of all operational processes; computer proficient).
• Results Oriented (Energetic self-starter; sets realistic goals; meets commitments; persistent, prioritizes daily to achieve results).
• Customer Service Advocate (flexible and adaptive; empathetic; passionate; ethical).
• Ability to multitask effectively and work in a fast paced and sometimes ambiguous environment, without compromising quality of work.
• Ability to draw valid conclusions, apply sound judgment in making decisions, and to make decisions under pressure.
• Must address others professionally and respectfully by actions, words and deeds.
• Detail oriented, organized, process focused, problem solver, self-motivated proactive, customer service focused.
• Displays independent judgment by willingness to make timely and accurate decisions based on available information that is sometimes vague or limited in nature.
• Ability to multitask effectively and work in a fast paced and sometimes ambiguous environment, without compromising quality of work.
• Ability to prioritize tasks and projects with limited direction, while understanding and contributing to the success of the company.

WORK ENVIRONMENT:

The work environment characteristics described here are representative of those an employee encounters while perf