Hybrid Operational Excellence Analyst I

at CareSource

• Job title: Operational Excellence Analyst I
• Job type: Full Time
• Experience level: Junior
• Salary: $46,500 - $74,500 per year
• Degree requirement: Associate's Degree
• Location requirements: Hybrid, Dayton, United States

About the role

• Operational Excellence Analyst overseeing compliance and HEDIS initiatives in healthcare operations. Monitoring claims, provider services, and conducting quality reviews collaboration with the management team.

Responsibilities

• 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
• Minimum of one (1) year of experience working in a business environment
• 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

• Bonus tied to company and individual performance
• Comprehensive total rewards package