Healthcare Operations Quality Assurance (Hybrid Warwick, RI)

Gainwell Technologies LLC•Any city, OH

1d•$50,400 - $72,000•Hybrid

About The Position

Great companies need great teams to propel their operations. Join the group that solves business challenges and enhances the way we work and grow. Working at Gainwell carries its rewards. You’ll have an incredible opportunity to grow your career in a company that values your contributions and puts a premium on work flexibility, learning, and career development. Your role in our mission: Under minimal supervision, performs routine to complex tasks that are related to various Medicaid related operations and policies. Continually monitors, assesses, and recommends improvements to Gainwell operations to ensure compliance with multi-layered and dynamic regulations and policies. Monitors quality metrics and service level performance metrics to ensure efficient and effective workflow practices. Assist business function managers and leaders in monitoring the performance of duties to address quality issues. Prepares and distributes monthly leadership presentation materials with our client. Manage distribution and retention of client ad hoc requests. Applies knowledge of established policies and procedures to research and resolve issues and ensure an individual case or complete process is compliant. Exercise independent judgment within defined practices and procedures to determine appropriate action. Evaluates unique circumstances and makes recommendations. Facilitator for various audits including but not limited to annual independent third-party audit of all operational practices; bi-annual PERM (federal CMS) audit of system and business processes; annual false claims act compliance audit; other periodic internal and external quality audits. Perform other duties as assigned and the business needs require. Involved in training of peers and will take the lead in areas of expertise. Will frequently work with Operations Management on special project or assignment that could include independent research and assessment of certain operations or processes with results documented in a briefing to management.

Requirements

Excellent oral and written communication skills
Strong analytical skills
Self-motivated with excellent time management and organizational skills
Ability to work independently as well as part of a team
Ability to effectively prioritize and handle multiple tasks and work under aggressive time constraints
Excellent problem solving and decision-making skills
Experience with Microsoft Office, Word, PowerPoint, Excel

Responsibilities

Performs routine to complex tasks related to various Medicaid related operations and policies.
Monitors, assesses, and recommends improvements to Gainwell operations to ensure compliance with regulations and policies.
Monitors quality metrics and service level performance metrics to ensure efficient and effective workflow practices.
Assists business function managers and leaders in monitoring performance of duties to address quality issues.
Prepares and distributes monthly leadership presentation materials with the client.
Manages distribution and retention of client ad hoc requests.
Applies knowledge of established policies and procedures to research and resolve issues and ensure compliance.
Evaluates unique circumstances and makes recommendations.
Facilitates various audits including annual independent third-party audit, bi-annual PERM audit, annual false claims act compliance audit, and other periodic internal and external quality audits.
Performs other duties as assigned.
Involved in training of peers and takes the lead in areas of expertise.
Works with Operations Management on special projects or assignments, including independent research and assessment of operations or processes.