POD Ops Consultant

OUR COMPANY CULTURE:Employees are united by our Lifetime Way Values & Behaviors that include compassion, pride, excellence, innovation and having fun! We aim to be an employer of choice by valuing workforce diversity, innovative thinking, employee development, and by offering competitive compensation and benefits.SummaryWithin a specific region, responsible for the identification, research, and resolution of complex or sensitive issues causing concern to the provider community. Present results of activities to internal and external audiences, coordinate internal corrective action, and identify proactive courses of action to prevent reoccurrence of identified issues.Provide support to POD Project Managers responsible for managing Provider projects related to: benefit design, pricing, financial arrangements, benefits administration, operational procedures, systems development, provider and subscriber contracts, legislative changes, and contracts.Ensure effective and efficient internal and external communication.Essential Responsibilities/Accountabilities Interact directly with the Delivery System regarding sensitive or complex service issues including: meet directly with providers to collect information; and follow-up to present research findings and issue resolution, including time frames.Provide supervision and oversight for the activities of RTR analysts. Maintain relationships and interact with key internal departments including: computer applications, Provider Relations, Claims Processing, and business analysts.Present research methodology results to internal departments, management, and other key constituencies.Create documentation of activities and assist in development of needed policies and procedures.Identify and report trends of provider concerns, which may be illustrative of key systemic issues .Support the activities of the POD Project Managers who act as a resource to Provider Contracting, Provider Contracting Support and other Excellus departments to ensure that new financial arrangements are both operational and implementable within the various insurance platforms Excellus-wide.Consistently demonstrates high standards of integrity by supporting the Lifetime Healthcare Companies’ mission and values and adhering to the Corporate Code of Conduct, and Leading to the Lifetime Way values and beliefs.Maintains high regard for member privacy in accordance with the corporate privacy policies and procedures.Regular and reliable attendance is expected and required.Performs other functions as assigned by management.Minimum QualificationsNOTE:We include multiple levels of classification differentiated by demonstrated knowledge, skills, and the ability to manage increasingly independent and/or complex assignments, broader responsibility, additional decision making, and in some cases, becoming a resource to others. In addition to using this differentiated approach to place new hires, it also provides guideposts for employee development and promotional opportunities. Bachelors Degree or Equivalent Experience 6-10 years of health care experienceExcellent written and verbal skillsExcellent public speaking and presentation skillsStrong analytical and problem resolution skillsStrong time management skillsHigh level of proficiency is Excel, Access, and Word