Kaiser Permanente PPO Specialist in Atlanta, Georgia
Business Consulting: includes analysis/evaluation of business and/or system process and functional requirements, development of business cases, client support during system development and implementation, development and maintenance of service level agreements. Develops relationships with upstream and downstream business partners. Develops/maintains and changes business processes, and understands the business processes of assigned partners and how they relate to our functional areas. Develops and recommends changes to business processes.
Full use of application of standard principles, theories, and techniques.
Uses professional concepts and company policies and procedures to solve a wide range of difficult problems in imaginative and practical ways.
Develops and leverages relationships with peers, supervisors and management.
Understand their functional area business processes and assigned area.
Independently initiates, investigates, documents, and analyzes client requirements in project areas such as: new/existing business operating models with innovative approaches to solutions support, market research of emerging or available product functionality and operational readiness assessment.
Assesses scope and impact of client business needs.
Develops business cases with cost, service, and benefit dimensions of proposed projects that are used at management and executive levels for funding and scope decisions.
Conducts and/or participates in the analysis of client business processes and functional requirements and in the preparation of appropriate documentation to communicate and validate the information.
Conducts workflows, process diagrams and gap analysis.
Identifies overlaps and related processes.
May assist in the development of project plans.
May use the associated project planning tools.
- Minimum three (3) years of experience, to include a minimum two (2) years in a consulting role.
Bachelor's degree in business/health care administration or related discipline OR four (4) years of experience in a directly related field.
High School Diploma or General Education Development (GED) required.
License, Certification, Registration
Identifies and documents cross-functional and/or cross-divisional, functional requirements, workflow, information sources and distribution paths, and system/process specifications.
Thorough knowledge of platforms of the assigned functional area.
Must be able to work in a Labor/Management Partnership environment.
Bachelor's degree in business/health care administration or related discipline.
Certification or advanced qualification by third party association that matches the function or field applicable to the business discipline preferred.
Experience interacting with members and customers.
Familiarity with medical terminology, benefit interpretation, and authorization/precertification of service.
PPO Insurance or Health Insurance Administration.
Provider network experience.
Medical office operations, Appointment Contact Center, or Member Service Contact Center experience or exposure.
Previous member/patient navigator or care coordination experience.
Dedicated to helping members and customers.
Strong customer service focus.
Ability to coordinate multiple components of care.
Excellent written and oral communication.
Organized and able to manage competing priorities.
Good judgement, resourcefulness, and problem solving skills.
Able to follow through with delegated tasks and accountabilities.
Strong documentation and computer skills.
Works independently with little supervision.
Forward thinking to predict member needs.
Ability to explain the KP value prop during conversations with members.
TITLE: PPO Specialist
LOCATION: Atlanta, Georgia
External hires must pass a background check/drug screen. Qualified applicants with arrest and/or conviction records will be considered for employment in a manner consistent with Federal, state and local laws, including but not limited to the San Francisco Fair Chance Ordinance. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, sexual orientation, gender identity, protected veteran, or disability status.