Administrative Operations Specialist

The Administrative Operations Specialist oversees and directs the strategic and operational functions of the VA Community Care Network (CCN) and Managed Care plans, ensuring seamless execution and policy formulation. Leads the development and implementation of policies, oversee credentialing processes, monitors daily operations, and manages all aspects of CCN and Managed Care training programs and materials. Serves as a critical liaison, coordinating and collaborating with internal and external stakeholders to enhance
the efficiency and effectiveness of care delivery and referral business transactions. Establishes and maintains high-level communication and professional relationships with referral sources, providers, Hearing Benefits Managers (HBM), and third-party entities to proactively address challenges and uphold the highest standards of patient care.

Plan Partner/ Third Party Administrator/ Hearing Benefit Manager
* Communicate effectively with the Third-Party Administrators / Hearing Benefits Managers contract
managers regarding credentialing, provider and/or location additions/terminations as well as any issues with authorizations/veteran referrals
* Maintain the third-party portals to include submitting providers to be credentialed, location additions/terminations
* Maintain knowledge of the latest VA and Managed Care plans requirements, changes and/or updates

Your Hearing Network/Providers and Access Points
* Handle provider enrollment requests and inquiries
* Verify provider credentialing status and ensure CMS approval and updated CAQH details
* Provide credentialed provider rosters and participate in collaboration meetings weekly
* Manage and resolve provider issues or complaints with escalation as needed
* Maintain the VA CCN overview page on the YHN portal
* Check the status of paid claims and orders as requested
* Use HSRM for authorizations and appointment updates, uploading documents as needed
* Conduct provider onboarding and refresher training for CCN processes
* Provide administrative support for credentialing, referrals, billing and other departments as needed

Tracking
* Update YHN database, YHN pipeline and credentialing spreadsheets with effective and termination
dates
* Update CCN fee schedule annually in YHN portal once posted on VA website
* Maintain sales reports and provide to team for business reviews
* New provider acquisitions as requested
* May perform miscellaneous tasks/projects as directed by manager.

Qualifications
* Education - High School diploma or equivalent
* Minimum 3 years' experience in the medical office environment or medical insurance industry.
* Proficient in insurance claims processing, including Explanation of Benefits (EOBs) and Veterans Affairs procedures.
* Strong computer skills with the ability to communicate clearly and effectively.
* Detail-oriented, adept at multitasking, and experienced in working with cross functional organizations.

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