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 is a hybrid role, working in the HQ office in Dayton, OH every Wednesday & Thursday. Facets enrollment processing experience preferred.
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 - $74,500.00CareSource 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 (hourly/salary):
SalaryOrganization Level Competencies
Fostering a Collaborative Workplace Culture
Cultivate Partnerships
Develop Self and Others
Drive Execution
Influence Others
Pursue Personal Excellence
Understand the Business
Top Skills
What We Do
Health Care with Heart. It is more than a tagline; it’s how we do business. CareSource has been providing life-changing health care to people and communities for nearly 30 years and we will continue to be a transformative force in the industry by placing people over profits.
CareSource is and will always be members first. Even as we grow, we remember the reason we are here – to make a difference in our members’ lives by improving their health and well-being. Today, CareSource offers a lifetime of health coverage to nearly 2 million members through plan offerings including Marketplace, Medicare Advantage and Medicaid. With our team of 4,000 employees located across the country, we continue to clear a path to better life for our members. Visit the "Life" section to see how we are living our mission in the states we serve.
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. If you’d like more information about your EEO rights as an applicant under the law, please click here: https://www.eeoc.gov/employers/upload/poster_screen_reader_optimized.pdf and here: https://www.dol.gov/ofccp/regs/compliance/posters/pdf/OFCCP_EEO_Supplement_Final_JRF_QA_508c.pdf
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