About the position
It takes great medical minds to create powerful solutions that solve some of healthcare’s most complex challenges. Join us and put your expertise to work in ways you never imagined possible. We know you’ve honed your career in a fast-moving medical environment. While Gainwell operates with a sense of urgency, you’ll have the opportunity to work more flexible hours. And working at Gainwell carries its rewards. You’ll have an incredible opportunity to grow your career in a company that values work-life balance, continuous learning, and career development. HMS makes the healthcare system work better for everyone. We fight fraud, waste, and abuse so people have access to healthcare—now and in the future. Using innovative technology and powerful data analytics, we help government and commercial payers reduce costs, increase quality, and achieve regulatory compliance. We also help consumers take a more active role in their own health. Each year, we save our clients billions of dollars while helping people live healthier lives. At HMS, you will develop new skills and build your career in a dynamic industry while making a difference in the lives of others.
Responsibilities
- Oversee vendor operations, ensuring alignment with organizational goals and contractual obligations.
- Manage inventory loads and transfers to meet operational requirements, ensuring accuracy through regular audits.
- Maintain accurate records of vendor performance and workforce efficiency.
- Onboard and offboard vendor agents, providing training and guidance as needed.
- Host weekly office hours for vendor agents to address inquiries and provide support.
- Communicate changes in carrier, provider, or claims processing guidelines to ensure compliance.
- Aid in resolving application, system, and technical issues escalated by vendor agents.
- Conduct regular QA assessments to ensure adherence to company standards and processes.
- Establish and oversee quality assurance programs to ensure compliance with industry regulations.
- Identify deficiencies and recommend actionable solutions to enhance team performance.
- Develop quality control measures to improve service delivery and operational efficiency.
- Monitor productivity metrics, including quality, efficiency, and revenue generation, to identify areas for improvement.
- Prepare and distribute comprehensive reports on inventory status, workforce productivity, and revenue performance.
- Track and analyze KPIs to measure workforce effectiveness and efficiency.
- Develop and maintain dashboards and reports using Tableau and other tools to provide real-time insights to leadership.
- Utilize Tableau, Teradata Studio, Deep Sea, other analytic tools, and Daily Reporting for performance monitoring and optimization.
- Analyze workforce trends and provide data-driven recommendations for operational improvements.
- Facilitate weekly leadership meetings to provide updates on vendor operations, productivity metrics, and revenue performance.
- Present findings, recommendations, and action plans to senior management.
- Create and maintain detailed documentation of processes, workflows, and reporting methodologies.
- Identify opportunities for process enhancements and lead implementation efforts.
- Develop, implement, and oversee a structured training program for new hires to ensure proficiency in company policies, procedures, and job functions.
- Conduct refresher training sessions for existing employees to reinforce best practices and compliance with SOPs.
- Regularly update training materials and SOPs to reflect changes in regulations, company policies, and industry best practices.
- Facilitate workshops and skill-building sessions to enhance employee competencies and operational efficiency.
- Collaborate with leadership to identify skill gaps and create targeted training initiatives to address deficiencies.
- Maintain training records and evaluate the effectiveness of training programs through assessments and feedback.
Requirements
- Bachelor’s degree in Business Administration, Analytics, Supply Chain Management, Education, or a related field preferred.
- Proven experience in workforce management, quality assurance, vendor coordination, training, and/or performance monitoring within a healthcare claims environment.
- Strong analytical skills with experience in data-driven decision-making.
- Proficiency in SQL, relational databases, Tableau for data visualization and dashboard creation.
- Experience with Tableau, Teradata Studio, Toad, Hyperion (Brio) or similar workforce optimization tools.
- Intermediate proficiency in Microsoft Excel, including pivot tables, VLOOKUP, and basic macros.
- Excellent verbal and written communication skills with the ability to interact effectively with stakeholders at all levels.
- Strong organizational skills, attention to detail, and ability to multitask in a fast-paced environment.
- Experience in developing and facilitating training programs is a plus.
Nice-to-haves
- Experience in developing and facilitating training programs.
Benefits
- Generous, flexible vacation policy.
- 401(k) employer match.
- Comprehensive health benefits.
- Educational assistance.
- Leadership and technical development academies.
