CDPHP Member Relations Specialist in Albany, New York

For more than 30 years, CDPHP has been providing outstanding health care coverage in the Capital Region of New York and beyond. Based in Albany, NY, the physician-guided not-for-profit offers plans in 24 counties. CDPHP cares deeply about the health and well-being of its members as well as its employees. The company values integrity, diversity, and innovation, and its corporate culture supports those values wholeheartedly. At CDPHP, the employees have a voice and are encouraged to make an impact at both the company and community levels through engagement and volunteer opportunities. CDPHP invests in employees who share these values and invites you to be a part of that experience.
The Member Relations Specialist is responsible for successfully administering, servicing, monitoring and growing the strategic relationships with members and providers in the CDPHP Service Center locations. The Member Relations Specialist will be the lead in providing effective support and education to the customers at the retail sites. The Member Relations Specialist will take a proactive and innovative approach to the member and provider relationship by tracking all high importance, and re-occurring member and provider issues as well as key provider and office related information. The Member Relations Specialist will be a licensed sales associate and will assist with enrollment efforts during the Medicare Annual Election Period and the NYS Health Benefits Exchange Annual Enrollment Period.
* High school diploma or GED required. Associates degree preferred.
* NYS Life, Accident and Health license required or secured within 90 days of employment as well as obtain AHIP certification for Medicare and any other training required as identified to remain compliant.
* Minimum 5 years customer service experience, 2 years health insurance experience preferred.
* Experience working with clinical personnel in supporting clinical initiatives in quality metrics (HEDIS, QARR, NCQA, etc), health care coding, state and federal regulations and reimbursement methodologies preferred.
* Demonstrated ability to determine, analyze and solve problems related to benefits, claims processing, claims and benefit appeals/complaints, enrollment, coordination of benefits and premium billing issues required.
* Demonstrated ability to successfully apply problem solving and time management methodology, balance multiple tasks as business needs arise while maintaining production and quality standards and meet deadlines.
* Working knowledge of provider reimbursement and payment methodologies.
* Must be able to effectively coordinate across, up, and down within the organization to resolve member and provider issues and implement strategic initiatives.
* Must have strong analytical skills and be an excellent strategic thinker.
* Strong detailed managed care product knowledge across all CDPHP lines of business.
* Demonstrated ability to successfully and positively interact with external customers including members, provider senior financial and operations management, physicians and business offices.
* Must have excellent verbal and written communication, interpersonal and organizational skills.
* Demonstrated ability to lead processes and obtain desired outcomes on time.
* Demonstrated ability to manage and shape strategic priorities to meet operational needs.
* Proficiency in Microsoft Word, Excel, PowerPoint and Access.
* Ability to adapt to regional travel.
* Comprehensive understanding of Commercial, Medicare and Medicaid reimbursement methodologies and rates required.
As an Equal Opportunity / Affirmative Action Employer, CDPHP will not discriminate in its employment practices due to an applicant s race, color, creed, religion, sex (including pregnancy, childbirth, or related medical conditions), sexual orientation, gender identity or expression, transgender status, age, national origin, marital status, citizenship, physical and mental disability, criminal record, genetic information, predisposition or carrier status, status with respect to receiving public assistance, domestic violence victim status, a disabled, special, recently separated, active duty wartime, campaign badge, Armed Forces service medal veteran, or any other characteristics protected under applicable law.

Employer's Job# 2598019951_3797
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