Job Description
Job Summary:
The Operational Excellence Analyst I is responsible for oversight and monitoring of Operations regulatory and accreditation requirements as well as specific HEDIS initiatives. This hybrid position works Wed & Thurs in office every week at the Dayton OH HQ location.
Essential Functions:
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
Education and Experience:
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
Competencies, Knowledge and Skills:
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
Working Conditions:
General office environment; may be required to sit or stand for extended periods of time
May be required to travel, estimated at less than 10%
Compensation Range:
$46,500.00 - $74,500.00 CareSource takes into consideration a combination of a candidate's education, training, and experience as well as the position's scope and complexity, the discretion and latitude required for the role, and other external and internal data when establishing a salary level. In addition to base compensation, you may qualify for a bonus tied to company and individual performance. We are highly invested in every employee's total well-being and offer a substantial and comprehensive total rewards package.
Compensation Type:
Salary
Competencies:
- Create an Inclusive Environment
- Cultivate Partnerships
- Develop Self and Others
- Drive Execution
- Influence Others
- Pursue Personal Excellence
- Understand the Business
This job description is not all inclusive. CareSource reserves the right to amend this job description at any time. CareSource is an Equal Opportunity Employer. We are dedicated to fostering an inclusive environment that welcomes and supports individuals of all backgrounds.
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CareSource is an equal opportunity employer and gives consideration for employment to qualified applicants without regard to race, color, religion, sex, age, national origin, disability, sexual orientation, gender identity, genetic information, protected veteran status or any other characteristic protected by applicable federal, state or local law.
