The purpose of Dignity Health Management Services Organization (Dignity Health MSO) is to build a system-wide integrated physician-centric, full-service management service organization structure. We offer a menu of management and business services that will leverage economies of scale across provider types and geographies and will lead the effort in developing Dignity Health’s Medicaid population health care management pathways. Dignity Health MSO is dedicated to providing quality managed care administrative and clinical services to medical groups, hospitals, health plans and employers with a business objective to excel in coordinating patient care in a manner that supports containing costs while continually improving quality of care and levels of service. Dignity Health MSO accomplishes this by capitalizing on industry-leading technology and integrated administrative systems powered by local human resources that put patient care first.
Dignity Health MSO offers an outstanding Total Rewards package that integrates competitive pay with a state-of-the-art, flexible Health & Welfare benefits package. Our cafeteria-style benefit program gives employees the ability to choose the benefits they want from a variety of options, including medical, dental and vision plans, for the employee and their dependents, Health Spending Account (HSA), Life Insurance and Long Term Disability. We also offer a 401k retirement plan with a generous employer-match. Other benefits include Paid Time Off and Sick Leave.
Responsible for establishing and maintaining positive relationships with various clients building strong, cohesive business partnerships. Works with internal staff, client representatives, and other contracted entities to deliver contractual performance standards and ensure customer service objectives are continually met.
JOB KNOWLEDGE, SKILLS & ABILITIES
1. Familiarity with third party administrator operations such as eligibility, prior authorization, claims administration and provider network administration.
2. Familiarity with managed care and self-insurance products and benefits.
3. Strong business acumen, customer service skills, follow-up, organizational and project management skills to ensure objectives and deadlines are consistently met.
4. Ability to establish and maintain positive business relationships, negotiate favorably, collaborate with others, and build consensus both externally and internally to achieve desired results.
5. Demonstrated ability to understand and interpret laws, rules and regulations as defined under state and Federal statutes along with remaining current on Healthcare Reform updates and changes.
6. Ability to understand Summary Plan Descriptions, Benefit Summaries, internal operations workflows, and claims policies & procedures.
7. Ability to understand and interpret regulatory concerns as applicable to the contract, including HIPAA privacy and security, CMS rules and regulations, and ERISA.
8. Excellent communication skills; able to read, write, and speak articulately, using established channels of communication and reporting relationships within the organization. Ability to communicate effectively with all levels of internal/external staff, management, clients, physicians and physician office staff.
9. Must be able to demonstrate relationship management, instill credibility and trust, and influence through collaboration.
10. Strong problem-solving abilities. Ability to identify issues and problems within administrative processes activities, and other relevant areas.
11. Ability to handle various situations in a professional manner, demonstrating excellent customer service at all times and ability to adapt to change
12. Must be able to work collaboratively with multiple internal departments as well as external organizations.
13. Willingness to work as part of a team, working with others to achieve goals, solve problems, and meet established organizational objectives.
14. Ability to continually re-prioritize to meet the needs of internal and external customers throughout the workday. Thorough knowledge of generally accepted professional office procedures and processes.
15. Ability to create professional documents using proper grammar, punctuation and appropriate reading level proficient in the use of Microsoft Office applications; Excel, Word, Access, Outlook, PowerPoint, Project.
16. Ability to use the following general office equipment correctly and safely: desktop computer for data entry and typing, copy machine, scanner and facsimile machine, and telephone equipment.
17. Must be able to travel to locations both in and out of town which may require overnight stays on occasion.
18. Must be reliable in attendance and timeliness to work schedules.
19. Adhere to dress code, good grooming, and personal hygiene habits.
20. Ability to maintain knowledge of and conform to company policies and procedures.
21. Ability to maintain strict confidentiality at all times.
ESSENTIAL DUTIES AND RESPONSIBILITIES
1. Develops, nurtures and maintains positive relationships with physician groups and directors, employer group client representatives, participants, internal DHMSO staff and contracted vendors to ensure a high level of satisfaction.
2. Serves as primary contact for providers and clients regarding complex service issues. Works closely with DHMSO staff to resolve and respond to client service issues.
3. Identifies and documents key operational trends, service issues and relevant data elements. Provides status reports to key stakeholders on monthly metrics and operational issues. Prepares management reports on regular basis.
4. Coordinates, schedules and prepares for Joint Operations Committee meetings with respective clients.
5. Oversees projects, contract requirements, and processes unique to contracted self-funded plans provided by subcontractors including SIMNSA, PTI-NPS, Networks by Design, First Health and other contracted vendors arranged for by DHMSO on behalf of self-funded clients.
6. Attend client events as a representative of DHMSO or to support client’s initiatives.
7. Create effective communication; conveying clear messages, identifying appropriate message content & delivery, active listening, and developing clear written communications.
8. Communicate with confidence difficult messages that support company decisions while maintaining credibility with clients, providers and client representatives.
9. Performs similar duties for other accounts as assigned.
Position requires ability to sit for extended periods of time while working on computer, talking on the phone and performing most work duties. Must be able to attend off-site meetings and set-up table with supplies, decorations, hand-outs. Must be able to use hands and fingers to enter data into computer, dial telephone, grasp files and reports. Must be able to lift and carry up to 20 pounds to transport files, reports and office supplies. Must be able to talk and hear to converse in person and on the telephone. Requires close up vision to read and work on computer, ability to adjust focus when changing tasks and peripheral vision while driving. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential job functions.
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