Operations Liaison

Job Description

Coventry Health Care, an $11.6 billion Fortune 500 organization, is a national managed health care company with 5.1 million members in all 50 states at the end of 2010. At Coventry Health Care, we are driven to ensure that every person and organization we serve receives the greatest possible value for their health care investment. We do this by providing a full range of competitive products through our seven core businesses – Commercial Risk, Medicare Advantage, Medicare Part D, Medicaid, Workers' Comp Services, FEHBP and Network Rental. We are committed to constantly improving our low-cost platform so that we can deliver the products and services that our customers want at a price they can afford. Coventry has the expertise, the experience, and the agility to craft the new products, the new processes and the new service needed to make healthcare more accessible to all Americans. We offer a competitive salary, excellent benefits (401K with company matching, paid training, comprehensive benefits including medical, dental, tuition reimbursement), vacation and sick time, and a business casual environment. This is a fast-paced, hands-on, team-oriented environment where creativity, initiative, and innovation are highly rewarded. ESSENTIAL RESPONSIBILITIES -Reviews, investigates, and applies guidelines to identify inaccuracies during the group/provider set-up, enrollment process or claims review process. - Provides ongoing analysis of the group/provider set-up and the enrollment or claims processes. Analyzes reports to validate accuracy of system. Identifies trends and recommends improvements to internal processes to improve customer service. - Assists with the review and resolution of vendor, group, broker, provider, interdepartmental and health plan provider inquiries related to the group/provider set-up, and enrollment or claims processes. - Monitors, analyzes and reports claim payment administration, benefit administration and enrollment processing errors. - Monitors the application of policies and procedures during the review process to identify deviations from industry standards. - Performs other duties as required. JOB SPECIFICATIONS - High school degree or equivalent. Bachelor’s degree preferred. - Significant experience (usually 4-5 years) in group set-up, enrollment and direct customer service. - Previous auditing or quality assurance experience preferred. - Knowledge of group set-up, eligibility requirements, ICD-9 and CPT codes. - Strong communication and interpersonal skills. - Strong analytic and problem solving abilities. Coventry Health Care is an Affirmative Action/Equal Opportunity Employer, and we are committed to building a talented and diverse team. To view details regarding this position and/or to apply for Coventry career opportunities, please visit our on-line career center, through Internet Explorer, at: http://jobs.coventryhealthcare.com & refer to job #170908- Operations Liaison