Associate Payor Operations Specialist

When you join the growing BILH team, you're not just taking a job, you’re making a difference in people’s lives.

The Associate Payor Operations Specialist is an entry-level professional position that supports the day-to-day operations of the BILHPN Payor Operations department. Working under the direction of the Director, Payor Operations, the Assistant supports the coordination and tracking of payor requirements, deliverables, communications, alerts, meetings, and follow-up activities Assist with value-based care agreements. The position works collaboratively with BILHPN teams and external payor partners and provides operational support to practices, provider groups, Revenue Cycle teams, and other stakeholders. The role is designed to build foundational knowledge of payor operations, value-based care, healthcare operations, provider practice workflows, revenue cycle processes, stakeholder engagement, and issue resolution while progressively developing the skills needed for increased responsibility.

Job Description:

Essential Duties & Responsibilities:

1. Assist with tracking payor deliverables, requirements, deadlines, alerts, notifications, and other payor-related action items.

2. Maintain accurate and organized inventories and tracking tools for payor deliverables, requests, communications, issues, and resolutions.

3. Coordinate with payor representatives and internal stakeholders to obtain information, confirm requirements, and support timely follow-up.

4. Support payor-specific meetings by coordinating schedules, preparing materials, documenting notes and action items, and completing follow-up.

5. Assist with the intake, documentation, and routing of payor communications, requests, and operational issues to the appropriate BILHPN team or stakeholder.

6. Assist with compiling payor requirements, contract-related information, reports, reference materials, and other documentation for internal stakeholders.

7. Support communication and dissemination of payor alerts, notifications, program updates, training information, and operational requirements under the direction of Payor Operations leadership.

8. Work with practices and provider groups to support questions, requests, payor-related operational needs, and follow-up, escalating matters requiring additional expertise or authority. 

9. Coordinate with Revenue Cycle teams and other operational stakeholders to help research and track payor-related claims, billing, reimbursement, enrollment, or workflow issues, as applicable.

10. Assist with gathering information from practices, providers, Revenue Cycle, operations, clinical teams, and other stakeholders to support resolution of payor-related issues.

11. Assist with monitoring deliverable status and identifying upcoming deadlines, missing information, barriers, or potential risks for escalation to Payor Operations leadership.

12. Assist with maintaining and refining standard workflows, reference materials, spreadsheets, Smartsheet trackers, and other tools used to manage payor operations.

13.  Prepare routine reports, spreadsheets, presentations, correspondence, meeting summaries, and status updates under the direction of Payor Operations leadership.

14. Develop and maintain effective working relationships with payor representatives, practices, provider groups, Revenue Cycle teams, BILHPN operational teams, and other stakeholders to facilitate collaboration and timely resolution.

15. Participate in training, mentoring, and professional development activities designed to build proficiency in payor operations and progressively assume greater responsibility.

Organizational Requirements:

• Maintain strict adherence to all BILH and BILHPN Policies.
• Maintain courteous and effective interactions with colleagues and providers and stake holders.
• Demonstrate an understanding of the job description, performance expectations, and competency assessment.
• Demonstrate a commitment toward meeting and exceeding the needs of our customers and consistently adheres to customer service standards.
• Participate in departmental and/or interdepartmental quality improvement activities. 
• Participate in and successfully completes Mandatory Education.
• Perform all other duties as needed or directed to meet the needs of the department.

Minimum Qualifications:

Education:

• Bachelor's degree in healthcare management, administration, public health, business administration, health services, communications, or a related field preferred. Equivalent relevant education and/or experience may be considered.

Licensure, Certification & Registration:

• None Required

Experience:

• 0–2 years of experience in healthcare operations, payor operations, provider relations, practice operations, revenue cycle, customer service, business administration, or a related field preferred.
• Healthcare or provider-facing experience is a plus but is not required for a strong entry-level candidate.

Skills, Knowledge & Abilities:

• Strong organizational skills and attention to detail.
• Excellent written and verbal communication skills.
• Professional interpersonal skills and a demonstrated service orientation.
• Ability to establish positive working relationships with payor representatives, practices, provider groups, Revenue Cycle teams, internal departments, and other stakeholders.
• Ability to manage multiple tasks, track follow-up, meet deadlines, and seek guidance when priorities conflict.
• Ability to learn and apply healthcare operations, value-based care, payor requirements, and organizational workflows.
• Strong documentation, meeting coordination, follow-through, and customer service skills.
• Proficiency with Microsoft Word, Excel, PowerPoint, Outlook, Teams, and related business applications.
• Familiarity with Smartsheet or similar tracking/workflow tools preferred.
• Demonstrated willingness to learn, receive coaching, and progressively assume greater responsibility.Strong analytical skills and proficiency in data analysis tools and software.
• Collaborative and team player.

Key Relationships:

1. BILHPN Payer Optimization Team           

2. BILHPN Payer Operations Team

3. BILHPN Provider Enrollment Team          

4. BILH and LCU Revenue Cycle Teams       

5. Practice and LCU staff and leadership    

6. BILHPN Clinical Excellence Team             

7. Payor Representatives and other external Payer Stakeholders    

8. Vendor Contacts, as applicable 

Physical Requirements & Environment: Required

For each category, select ONE option from choices below by placing an X in the space to the left of the entry.

Mental and Visual Attention Required

a)           The position requires basic mental and visual attention much or all of the time

b)           The position requires periods of concentrated mental and visual attention.

c)   X      The position requires a high degree of mental and visual concentration.

Physical Exertion

Weight

d)   X      Nature of work requires lifting or moving light weight (up to 20 pounds).

e)           Nature of work requires lifting or moving medium weight (over 20 and up to 75 pounds).

f)            Nature of work requires lifting or moving heavy weight (over 75 pounds).

Dexterity

g)   X      Flow of work and character of duties require average manual coordination.

h)           Flow of work and character of duties require above average manual coordination.

i)            Flow of work and character of duties require high manual coordination.

Range of  Motion

j)   X       Duties require average range of motion.

k)           Duties require above average range of motion.

l)            Duties require high range of motion.

Physical Conditions

m)   X    Performance of duties allows for variation in positioning and tasks.

n)           Performance of duties requires remaining in position for prolonged periods of time.

Repetitive Motion

o)           Assignments require occasional repetitive motion.

p)           Assignments require frequent repetitive motion.

q)   X      Assignments require constant repetitive motion.

Working Conditions

r)   X      Working conditions include minimal exposure to elements such as odor, noise, dust, chemicals, temperature extremes or airborne pathogens.

s)           Working conditions include occasional exposure to elements such as odor, noise, dust, chemicals, temperature extremes or airborne pathogens.

t)            Working conditions include continuous exposure to elements such as odor, noise, dust, chemicals, temperature extremes or airborne pathogens.

Exposure to Hazardous Materials

u)   X      Performance of duties generally does not involve exposure to hazardous materials.

v)           Performance of duties occasionally involves exposure to hazardous materials.

w)          Performance of duties frequently involves exposure to hazardous materials.

Patient Care Conditions (select ALL that are applicable)

x)           Position entails exposure to blood and body fluids, standard precautions must be used.

y)           Assignments include transporting, transfer and positioning of patients.

z)           Incumbent must be continuously prepared to prevent a patient fall.

Sensory Requirements  (select ALL that are applicable)

aa)         Performance of duties requires the ability to discern and identify colors

bb)        Performance of duties requires the ability to discern sharp from dull and hot from cold

cc)         Performance of duties requires the ability to hear soft and loud noises

Patient Care/Patient Contact Designation (check only one of the items listed below)

_ Position has a direct impact upon health outcomes of the patient.

_ Position facilitates the process that may impact patient access to services.

X  No patient care/contact, and does not facilitate the patient care process or directly impact health outcomes.

Pay Range:

$25.00 USD - $38.00 USD

The pay range listed for this position is the annual base salary range the organization reasonably and in good faith expects to pay for this position at this time. Actual compensation is determined based on several factors, that may include seniority, education, training, relevant experience, relevant certifications, geography of work location, job responsibilities, or other applicable factors permissible by law. 

As a health care organization, we have a responsibility to do everything in our power to care for and protect our patients, our colleagues and our communities. Beth Israel Lahey Health requires that all staff be vaccinated against influenza (flu) as a condition of employment.

More than 35,000 people working together. Nurses, doctors, technicians, therapists, researchers, teachers and more, making a difference in patients' lives. Your skill and compassion can make us even stronger.

Equal Opportunity Employer/Veterans/Disabled