CareSource

Operational Excellence Analyst I

CareSource

full-time

Posted on:

Location Type: Hybrid

Location: Dayton • Ohio • 🇺🇸 United States

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Salary

💰 $46,500 - $74,500 per year

Job Level

Junior

About the role

  • 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
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