Operations Analyst
Community Health Plan of Washington
full-time
Posted on:
Location Type: Remote
Location: Remote • Washington • 🇺🇸 United States
Visit company websiteSalary
💰 $73,010 - $111,710 per year
Job Level
Mid-LevelSenior
About the role
- Responsible for sustaining processes and executing process improvement and quality monitoring within Claims Operations and the business processes impacted by Operations data and systems.
- Responsible for State and CMS claims benefit interpretation and application, and oversight of system benefit and pricing configuration.
- Gather business requirements for claims benefit configuration to support system updates, enhancements and implementation of new products.
- Facilitate the development and execution of user acceptance scenarios and scripts for testing of system changes, implementations, and enhancements.
- Peer review and support system enhancements and configuration of vendor systems.
- Provide support for electronic data interchange (EDI) data files and CHPW web-based interfaces.
- Interpret, monitor, and ensure compliance with state, CMS, OIC requirements; pricing, audit performance, encounter data submissions/reporting, and vendor management.
- Other duties as assigned.
Requirements
- Bachelor’s degree in health care or related field or an equivalent combination of education and highly relevant experience required.
- Minimum three (3) years’ managed care/health plan operations experience required, with proven broad knowledge and execution of quality improvement methods and tools.
- Minimum two (2) years’ business/operations analysis experience in a related field required.
- Background in Medicaid and Medicare claims adjudication, benefits configuration, claims coding, electronic data interface, and encounter data reporting preferred.
- Experience in managed care/health plan operations and business/operations analysis experience in a related field.
Benefits
- Medical, Prescription, Dental, and Vision
- Telehealth app
- Flexible Spending Accounts, Health Savings Accounts
- Basic Life AD&D, Short and Long-Term Disability
- Voluntary Life, Critical Care, and Long-Term Care Insurance
- 401(k) Retirement and generous employer match effective the 1st of the month following or coinciding with the employee’s start date
- Wellness programs (Employee Assistance Program and Mental Fitness app)
- Financial Coaching, Identity Theft Protection
- Paid Time Off (PTO) including PTO accrual starting at 17 days per year
- 40 hours Community Service volunteer time
- 10 standard holidays, 2 floating holidays
- Compassion time off, jury duty
- A monthly stipend to offset work-from-home expenses for roles that are 100% remote
Applicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard skills
process improvementquality monitoringclaims benefit interpretationsystem benefit configurationbusiness requirements gatheringuser acceptance testingelectronic data interchange (EDI)claims codingencounter data reporting
Soft skills
communicationcollaborationanalytical thinkingproblem-solving
Certifications
Bachelor’s degree in health care