BC&L INC

Role Description The Medical Management Operations Coordinator reports to the Admin team Supervisor and provides high-level virtual support to the Vice President & Director of Medical Management at Prime Dx, playing a key role in ensuring smooth implementations and day-to-day operations. This flexible, catch-all position requires a proactive and organized professional who can manage a wide range of administrative responsibilities in a remote environment. - Manage daily communications, including phone calls, emails, ticketing system, and special requests. - Support department operations by updating templates, editing PDFs, and contributing to audits, projects, and process improvements. - Schedule, organize, and assist with orientation and tech-stack training for new team members. - Prepare and distribute regular reports and presentations; maintain secure digital filing systems and ensure compliance when handling confidential information. - Conduct internal audits and keep team resources accurate and up to date. - Coordinate external member surveys and research individual requests as assigned. - Maintain and update the team’s SharePoint, intranet page, policies, and procedures. - Serve as a backup to other administrative and support teams when needed. - Provide direct support for special projects assigned by the Administrative Team Supervisor, Director/VP, fostering a professional and collaborative virtual team environment. - Perform other duties as assigned. Qualifications - High school diploma required; additional education or certifications preferred. - Proven experience as an administrative or office assistant, preferably in a healthcare or operations setting. - Proficiency in Microsoft Office, particularly Excel, Word, and PowerPoint. - Familiarity with office management tools, digital filing systems, and virtual collaboration platforms (e.g., Teams, SharePoint, Zoom). - Excellent time management skills and the ability to prioritize and manage multiple tasks. - Strong attention to detail and effective problem-solving abilities. - Outstanding written and verbal communication skills. - Highly organized, adaptable, and able to thrive in a remote team environment. Requirements - Must be able to remain in a stationary position for 80% of the time. - Must use close visual acuity to perform activities such as preparing and analyzing data and figures, transcribing, viewing a computer terminal, and expansive reading. - Must be able to lift or move items up to 18lbs. - Must have the ability to move files, open filing cabinets, and bend or stand as necessary.

Job DetailsJob Location: Corporate Austin - Austin, TX 78729Salary Range: $88,000.00 - $95,000.00 Salary/yearThe Oncology Nurse Coach is a clinically strong, relationship-driven nurse responsible for engaging members with active cancer diagnoses across the continuum from new diagnosis through treatment, symptom management, surveillance, and graduation. This role is not 'check-in and document.' It is high-touch, high-accountability cancer management: reviewing benefits as they relate to ensuring the right diagnosis and treatment, speeding access timely and appropriate care, supporting adherence, providing side-effect and red-flag education, coordinating with the oncology team, and reducing avoidable waste, delays, ED visits, admissions, and total cost of care while optimizing member outcomes. You will be measured by your ability to: Engage oncology members early and sustain participation through treatment, recovery, or graduation Accelerate access to appropriate care including in-network providers, second opinions, and timely treatment Improve adherence and symptom control while increasing member confidence and self-management Reduce avoidable utilization and waste while improving the member and caregiver experience Escalate appropriately to palliative care, hospice, behavioral health, care navigation and case management, or other supportive resources Key responsibilities may include: Conduct telephonic/video oncology assessments; build a personalized, member-centered care plan with measurable goals Review benefit plan design and explain how benefits apply to diagnosis, staging, testing, treatment, and follow-up care Support Stage 2 or higher cancers, leukemia, lymphoma, and other higher-acuity cancers with deeper coordination across the treatment journey Facilitate timely second opinions and support members through review of diagnosis, staging, and treatment options in accordance with clinical guidelines. Help speed time to the right diagnosis, right treatment, and right place of service to reduce waste and improve clinical outcomes Provide proactive education on expected side effects, symptom monitoring, red flags, and when to seek urgent care Support symptom management and reduce avoidable ER visits and admissions through coaching, triage guidance, and close follow-up Coordinate MD appointments, imaging, labs, infusion, radiation, surgery, and community services to reduce delays in care Collaborate with oncologists, PCPs, surgeons, palliative care, hospice, pharmacy, and internal teams including Care Navigation and Case Management Identify opportunities for palliative care, pain and symptom support, and early hospice referral when clinically appropriate Research and support access to clinical trials, national and local non-profit resources, and financial assistance programs Document all encounters accurately in the care management platform with clear assessments, goals, interventions, and outcomes Contribute to 1-month, quarterly, annual, and ad hoc reporting; create concise outcomes and ROI narratives for internal and client leadership Qualifications What We’re Looking For (Nobody’s Perfect, But Experience is a Plus!) BSN preferred with valid and active compact RN license Minimum of 3-5 years of clinical nursing experience, with oncology nursing, oncology case management, or oncology navigation experience required Strong clinical skills with a comprehensive knowledge of cancer diagnosis, staging, treatment modalities, supportive care, and survivorship needs Excellent communication and interpersonal skills, with the ability to manage sensitive and emotionally complex situations Demonstrated experience driving high member engagement, adherence, and self-management outcomes Strong assessment and triage judgment, including recognition of deterioration and need for escalation Ability to work independently and as part of a multidisciplinary team Proficiency in care management platforms, medical software, and Microsoft Office Certifications preferred: OCN, CCM, or other relevant specialty certification Experience supporting self-funded employer populations, high-cost claim mitigation, or utilization reduction initiatives Understanding of evidence-based oncology guidelines, side-effect management, and care gap closure strategies Maintain a professional remote-working and HIPAA compliant workspace, with adherence to company policies, documentation standards, and quality management requirements The Oncology Nurse Coach is a clinically strong, relationship-driven nurse responsible for engaging members with active cancer diagnoses across the continuum from new diagnosis through treatment, symptom management, surveillance, and graduation. This role is not 'check-in and document.' It is high-touch, high-accountability cancer management: reviewing benefits as they relate to ensuring the right diagnosis and treatment, speeding access timely and appropriate care, supporting adherence, providing side-effect and red-flag education, coordinating with the oncology team, and reducing avoidable waste, delays, ED visits, admissions, and total cost of care while optimizing member outcomes.

This description is a summary of our understanding of the job description. Click on 'Apply' button to find out more. Role Description In this role, you will leverage your expertise in electronic data interchange (EDI) to ensure accurate, timely, and secure data exchanges between Soluta’s systems (including benefit administration platforms) and various insurance carriers. This is a remote position, and the EDI Analyst will play a critical part in implementing new EDI feeds, maintaining existing integrations, and troubleshooting issues in the group insurance space. The ideal candidate has a strong background in EDI configuration and mapping, excellent problem-solving abilities, and the communication skills to work effectively with both technical and business stakeholders. Responsibilities - Design, implement, and maintain EDI file integrations (e.g., ANSI X12 834) between Soluta’s platform and insurance carriers. - Gather and translate business and carrier requirements into detailed EDI mapping specifications. - Conduct end-to-end testing and coordinate test cycles to ensure accurate EDI transactions. - Monitor EDI transmissions and proactively troubleshoot errors or carrier rejections. - Act as liaison for carrier EDI teams and clients to resolve discrepancies and manage file updates. - Configure and manage secure FTP/SFTP connections for compliant data exchange. - Maintain thorough documentation and recommend improvements for EDI processes and tools. - Handle data segregation or consolidation for single-tenant and multi-tenant EDI file models. - Collaborate with internal teams to align EDI integrations with system architecture and client needs. - Perform other duties as assigned. Qualifications - Bachelor’s degree in a related field or equivalent experience in a technical or analytical role. - 2–4 years of hands-on EDI experience with carrier integrations in the group insurance space. - Strong technical skills with data formats, integration tools, encryption, and validation. - Clear and professional communicator, able to explain technical concepts to non-technical audiences. - Proven problem-solver with experience in root cause analysis and implementing long-term fixes. - Proficient in Microsoft Office, especially Excel for data analysis and Word/Access for documentation and queries. - Experience building or managing EDI integrations using platforms like bswift, Employee Navigator, or Selerix. - Strong knowledge of HIPAA 834, LIMRA LDEx, and various custom flat-file formats for benefits enrollment. - Skilled in configuring, testing, and troubleshooting FTP/SFTP connections and automated file transfers. - Familiar with both single-tenant and multi-tenant EDI integration models and related best practices. - Working knowledge of SQL or scripting for data manipulation is a plus. - Understanding of HIPAA compliance and data security standards in EDI transmissions. Physical Requirements - Prolonged periods sitting at a desk and working on a computer. - Must be able to lift to 15 pounds at times.