Oversight and monitoring of Operations regulatory requirements
Oversight and monitoring of Operations specific HEDIS initiatives and accreditation requirements
Identify and perform oversight and monitoring of Claims, Provider Appeals, Provider Services (claims processing only), Provider Life Cycle and/or Enrollment processes
Generate monthly reporting, analyze and recommendations based on findings
Conduct monthly quality reviews with the Operations Management team
Work cross-functionally with the Operations Management team to identify process gaps and drive improvements
Perform any other job duties as requested
Requirements
Associates of Science/Arts degree in Management Information Systems (MIS) or related field or equivalent year of relevant work experience is required
Minimum of one (1) year of experience working in a business environment is required
Two to five (2 to 5) years of experience in Healthcare Operations is preferred
Two to five (2 to 5) years of experience translating business requirements into technical specifications is preferred
Intermediate proficiency level with Microsoft Office Suite, including Project and Visio
Advanced troubleshooting and problem-solving capabilities
Data analysis and process mapping
Overall knowledge and understanding of Operations-related systems, technical specifications and processes
Basic understanding of claims processing
Ability to conduct oversight, monitoring and auditing of operational areas
Ability to understand accreditation and regulatory requirements
Ability to document and maintain business and system requirements including process flows
Ability to analyze processes and produce recommendations for improvements
Excellent written and verbal communication skills
Effective listening and critical thinking skills
Strong interpersonal skills and high level of professionalism
Effective problem solving skills with attention to detail
Ability to work independently and within a team
Ability to develop, prioritize and accomplish goals
Benefits
substantial and comprehensive total rewards package
health insurance
retirement plans
bonuses
Applicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard skills
data analysisprocess mappingclaims processingoversightmonitoringauditingtechnical specificationsreportingtroubleshootingproblem-solving
Soft skills
written communicationverbal communicationlisteningcritical thinkinginterpersonal skillsprofessionalismattention to detailindependenceteamworkgoal prioritization