Summary of Position
- Lead the technical implementations for the ASO, Shared Administration and Network Access Programs with Third Party Administrators (TPAs) as required.
- Manage the maintenance and enhancement of ASO including Shared Admin and Network Access product offerings.
- Collaborate with marketing teams to develop materials and tools that support sales and education efforts.
- Collaborate with internal stakeholders to resolve issues related to the needs of the ASO, Shared Administration and Network Access programs.
- Provide input on benefit design changes and assist in documenting updates to ensure clarity and consistency for ASO, Shared Admin and Network Access clients.
- Partner with Sales/Account management teams by providing expertise of technical documentation, ASO, Shared Administration and Network Access product and process.
- Research market trends, competitor products, and regulatory changes to provide insight and support product updates and improvements
Principal Accountabilities
- Manage operational processes specific to ASO, Shared Admin, Network Access and Large Group segments.
- Work with IT and operations teams to ensure systems are configured correctly for ASO, Shared admin, Network Access and Large Group segments including eligibility, billing, and reporting functions.
- Manage the implementation and the technical specifications of ASO , Shared Administration and Network Access.
- Monitor any implementation updates related to ASO compliance, including ERISA, ACA, and HIPPA regulations.
- Assist in analyzing market trends, client feedback, and competitor offerings to identify opportunities for enhancements.
- Contribute to the development of strategies for improvement and growth of ASO product offerings.
- Serve as the business SME to internal & external constituents on the ASO, Shared Administration and Network Access programs.
- Develop and maintain cross-functional relationships. Engage the appropriate business/operations areas to research issues identified for ASO, Shared Administration and Network Access programs. Assist in resolving escalated client issues related to operational or benefit design challenges.
- Manage and respond to large group ASO client questions, offering detailed explanation of plan structures and operational processes.
- Lead internal/external conference calls: planning, follow up, meeting scheduling, documentation preparation and call notes distribution.
- Manage Sales/Account management teams by providing explanation of the ASO, shared Administration and Network Access programs workflows.
Qualifications:
- Bachelor's Degree.
- 4 - 6+ years of relevant, professional work experience required
- Extensive knowledge of ASO products, funding arrangements, and related services required
- Strong understanding of health care regulations (ERISA, ACA etc.) and compliance requirements required
- Familiarity with health plan pricing, claims administration and benefit designs required
- Experience in claims and EDI transactions (837, 835, etc.) required
- Additional experience/specialized training may be considered in lieu of educational requirements required
- Self-starter: ability to work on issues without being prompted and seeing issues through to completion required
- Detail oriented; analytical and problem identification and resolution skills required
- Strong data analysis skills; ability to discern patterns and trends required
- Excellent collaboration skills and the ability to influence management decisions required
- Excellent communication skills (verbal, written, presentation, interpersonal) with all types/levels of audience required
- Proficient with MS Office (Word, Excel, PowerPoint, Outlook, Teams, SharePoint, etc.) required
- Knowledge of/proficiency with applicable systems and platforms (FACETS, TruProvider and Salesforce) required
- Exceptional organizational and project management abilities to handle multiple priorities preferred
Additional Information
- Requisition ID: 1000002348
- Hiring Range: $63,000-$110,000
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EmblemHealth
Feb 18, 2025