HCS Operations Inventory & Quality Analyst (Eligibility)

Performant Corp • Plantation, FL

2d • Remote

About The Position

The HCS Operations Inventory & Quality Analyst (Eligibility), leverages strong knowledge of healthcare eligibility, healthcare claims, eligibility validation practices, Coordination of Benefits and Third-Party Liability (COB/TPL), or Medicare Secondary Payer (MSP), plus strong data analysis and technical skills to support inventory management, process documentation, and production QA process for assigned operations teams in the Eligibility organization.

Requirements

• Knowledge and experience with rules around Medicaid / Medicare COB Other TPL business models and products
• Skilled working with operations systems, tools, and applications for collecting and reporting data as well as identifying trends.
• Demonstrated ability to work with large volumes of healthcare eligibility and claims data.
• Intermediate skills in MS Excel required.
• Utilization of SQL to run queries.
• Strong general system and application skills with ability to quickly develop expertise in new systems and applications.
• General knowledge of 270/271, 834, 277, 837, 835 highly desired
• Professional verbal and written communication with good presentation skills
• Ability to follow, document, and teach, as well as support improvement of, processes, procedures, and workflow.
• Ability to work independently with minimal supervision
• Strong analytical and problem-solving skills
• Skilled at gathering, researching, interpreting, and documenting data and requirements for projects and/or complex problem solving.
• Ability to produce results and maintain positive attitude in a dynamic environment.
• Self-motivated and thrives in a fast-paced business operations department performing multiple tasks cohesively, with keen attention to detail.
• Protects patients’ privacy, understands, and adheres to HIPAA standards and regulations.
• Self-motivated and thrives in a fast-paced office environment performing multiple tasks cohesively, with keen attention to detail.
• Ability to adapt quickly and transition effectively to changing circumstances, client requirements, assignments, and business needs.
• Ability to consistently perform job responsibilities.
• Bachelor’s degree in relevant field, or equivalent combination of education and experience.
• At least three (3) years of directly related progressive experience (claims, billing, eligibility, Medicaid/Medicare, etc.), including Coordination of Benefits and Third-Party Liability, demonstrating depth and breadth of knowledge and capability required for the position.
• Minimum two (2) years relevant experience demonstrating ability to work with large volumes of healthcare eligibility or client data, including data reporting, modeling, and analysis.
• Minimum 1 year of relevant experience in role(s) with responsibility for applying subject matter expertise to operations workflow, contributing to the set-up of new clients or programs, projects, quality/auditing, direct or indirect staff oversight or training, etc. and contributing to the development of infrastructure and continuous improvement for department output.
• Other requirements and qualification may apply.

Nice To Haves

• Ability to develop basic queries a plus.
• Familiarity with JIRA a plus

Responsibilities

• Work closely with the operations teams and data team to ensure inventory is accurately and efficiently distributed/assigned and transferred across teams based upon applicable inventory type workflow and requirements.
• Conduct auditing of operations team activities on inventory to validate compliance with internal requirements, client contracts, regulatory requirements, and industry quality standards.
• Facilitate communications and collaborate to convey/clarify requirements for inventory data flow based upon client/type/source serving as a liaison between the operations and eligibility & analytics data team.
• Utilize SQL queries (and develop queries as may be needed) and leverage subject matter knowledge, independent judgement, and analytical skills to: Test data transfer/flow results. Perform audit activity. Create and maintain regular internal/external activity and metrics reporting; and Other support for operations workflow and activity.
• Mentors operations team and data team on paper and electronic claims processes
• Creates and maintains internal and external reporting as needed.
• Contribute to development and continuous improvement of operational tools, processes and procedures for quality and inventory.
• Provides Supervisors/Management with staff production quality results, as well as any insights for feedback/coaching/training opportunities based upon themes/trends identified to correct areas of quality deficiency and improve overall results.
• May support management with developing or delivering training and tools for skills development to increase capability and effectiveness of analysts.
• Operates under minimal supervision to deliver results aligned with business goals, given guidance in the form of high-level objectives.
• Follows and complies with company, departmental and client program policies, processes, and procedures.
• Responsible for utilizing resources to ensure compliance with client requirements, HIPAA, as well as applicable federal or state regulations.
• Successfully completes, retains, applies, and adheres to content in required training as assigned.
• Correct areas of deficiency and/or areas of opportunity for improvement received from management.

Benefits

• Machinify offers a wide range of benefits to help support a healthy work/life balance.
• These benefits include medical, dental, vision, HSA/FSA options, life insurance coverage, 401(k) savings plans, family/parental leave, paid holidays, as well as paid time off annually.
• For more information about our benefits package, please refer to our benefits page on our website or discuss with your Talent Acquisition contact during an interview.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level