Clinical Operations Spec

GEHA; Lee's Summit (MO); Hybrid; USD 42,000 - 62,000; Full time

Benefits offered by this job

Health benefits

401(k) with company match

Hybrid work model

Paid Time Off

Tuition Assistance

Life Insurance

Short/Long-term Disability

Job summary

G.E.H.A, headquartered in the Kansas City area, seeks an administrative Associate to support Clinical Operations. You will engage with members and providers to explain GEHA benefits and programs, and identify cases for internal and external clinical programs.

Posted as a full-time role with hybrid work options in Lee's Summit, MO. The position requires basic healthcare knowledge, strong communication skills, and proficiency with MS Office tools.

Qualifications

• Requires two years (60 credit hours) of college or 2 years of healthcare experience.
• Requires intermediate proficiency with technology applications and systems.
• Requires effective written and verbal communication skills.
• Must reside in the Kansas City Metro.

Responsibilities

• Performs routine administrative workflow tasks supporting Clinical Operations.
• Educates members and providers about GEHA benefits and programs.
• Identifies cases for internal and external Clinical programs.
• Coordinates communication and responses with internal/external customers regarding care management.

Skills

Communication

Healthcare experience

PHI / HIPAA awareness

Education

60 credit hours

Tools

Microsoft Office

Excel

Outlook

Teams

Job description

Company Overview

Government Employees Health Association, Inc. (G.E.H.A) is a nonprofit member association that provides health and dental benefits that millions of federal employees and retirees, military retirees and their families have counted on since 1937. Offering one of the largest health and dental benefit provider networks available to federal employees in the United States, G.E.H.A empowers health and wellness by meeting its members where they are, when they need care.

Government Employees Health Association, Inc. (G.E.H.A) is a nonprofit member association that provides health and dental benefits that millions of federal employees and retirees, military retirees and their families have counted on since 1937. Offering one of the largest health and dental benefit provider networks available to federal employees in the United States, G.E.H.A empowers health and wellness by meeting its members where they are, when they need care. G.E.H.A has one mission: To empower federal workers to be healthy and well.

Role Summary

Performs routine administrative workflow tasks that support functions of Clinical Operations. Engages and educates members and providers about G.E.H.A benefits and programs. Identifies cases for internal and external Clinical programs.

SKILLS Summary

Uses various communication methods to identify and solicit information from providers and vendors as relevant to clinical and business need. Coordinates, reviews and investigates claims to determine the medical necessity and appropriateness of the care Determines simple cases that require review by Medical Director, Pharmacist or nurse. Interprets medical review results to determine compliance with contract provisions. Reports suspicions of compliance, clinical, quality, and regulation concerns Identifies cases for care and cost management Recommend benefit allowances in alignment with contract liabilities Actively engages in communication and response with internal and external customers regarding care management, products, and services Directs processing of contractual benefits after investigation is complete Escalates complex cases to senior team member.

Requirements

Requires two years (60 credit hours) of college or 2 years of healthcare experience. Additional years of qualifying work experience may be considered in lieu of formal education. Requires intermediate proficiency with technology applications and systems. Requires experience using Microsoft office products, i.e., Outlook, Excel, Word, Teams. Requires effective written and verbal communication skills. Must reside the Kansas City Metro.

Work-At-Home Requirements

Must have the ability to provide a non-cellular High Speed Internet Service such as Fiber, DSL, or cable Modems for a home office. A minimum standard speed for optimal performance of 30x5 (30mpbs download x 5mpbs upload) is required. Latency (ping) response time lower than 80 ms Hotspots, satellite and wireless internet service is NOT allowed for this role. A dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information

Benefits

• Health/Vision/Dental benefits effective day one
• 401(k) retirement plan: company match – dollar for dollar up to 4% employee contribution (pretax or Roth options) plus a 6% annual company contribution
• Robust employee well-being program
• Paid Time Off
• Personal Community Enrichment Time
• Company-provided Basic Life and AD&D
• Company-provided Short-Term & Long-Term Disability
• Tuition Assistance Program

Employment Equity

G.E.H.A is an Equal Opportunity Employer, which means we will not discriminate against any individual based on sex, race, color, national origin, disability, religion, age, military status, genetic information, veteran status, pregnancy, marital status, gender identity, and sexual orientation, as well as all other characteristics and qualities protected by federal, state, or local law. G.E.H.A will not discriminate against employees or applicants because they have inquired about, discussed, or disclosed their compensation or the compensation of another employee or applicant. We are committed to creating an inclusive environment for all employees.

Location

G.E.H.A is headquartered in Lee's Summit, Missouri, in the Kansas City area.

Work Flexibility

We recognize the importance of balance and flexibility and offer hybrid and work-from-home options for many of our roles.

Join Us

Your FUTURE is here with us –COME GROW WITH G.E.H.A! Benefits start on day one! Great 401(k) match! Tuition assistance programs! Professional development! Advancement opportunities! For additional information, please visit GEHA Careers.