Out of Network Analyst

Claritev•New York, NY

2d•$43,000 - $43,000

About The Position

At Claritev, we pride ourselves on being a dynamic team of innovative professionals. Our purpose is simple - we strive to bend the cost curve in healthcare for all. Our dedication to service excellence extends to all our stakeholders -- internal and external - driving us to consistently exceed expectations. We are intentionally bold, we foster innovation, we nurture accountability, we champion diversity and empower each other to illuminate our collective potential. Be part of our amazing transformational journey as we optimize the opportunity towards becoming a leading technology, data, and innovation voice in healthcare. Onward and Upward!!! JOB SUMMARY: An OON Analyst is essential for ensuring a company's daily operations run smoothly and efficiently. Their role involves a range of tasks, including managing workflow distribution, claim reassignment, data tracking, daily reporting, and maintaining standard spreadsheets. They also provide support and oversight to various departmental queues. Serving as a key link between departments, the OON Analyst plays a pivotal role in achieving the organization's operational goals and promoting growth.

Requirements

Minimum High School Diploma or GED.
Minimum 2 years of experience in a data tracking and reporting setting.
Communication (written, verbal and listening), analytical, organizational, prioritization, technical, etiquette and interpersonal skills.
Ability to use Microsoft Teams and related communication applications.
Ability to use software and hardware peripherals related to job responsibilities including MS Office Suites with preferred proficiency with Word, Excel, and other database software.
Strong excel knowledge (reading, building, and manipulating reports); including formula's and pivot tables.
Ability to use software and hardware peripherals related to job responsibilities including Scribe, OneDrive, FORMs, and other related MS Office Suites.
Ability to track tasks for prioritization, setting deadlines, and maintaining visibility on task progress through platforms like Microsoft Planner, Microsoft Lists, and Outlook calendars, ensuring projects stay on track.
Ability to be flexible in quickly shifting priorities and keeping up with changes across multiple tasks in a fast-paced environment while maintaining a positive and cooperative demeanor.
Ability to demonstrate strong technical skills.
Ability to identify issues and escalate for course of action for resolution.
Ability to elicit trust and credibility with all levels of the organization.
Ability to adjust/alter schedule to meet deadlines.
Ability to work independently and handle confidential information.
Ability to work in a fast-paced reporting environment to meet deadlines and production expectations.
Individual in this position must be able to work in a standard office environment which requires sitting and viewing monitor(s) for extended periods of time, operating standard office equipment such as, but not limited to, a keyboard, copier and telephone.

Responsibilities

Design and maintain clear operational guides to ensure consistent processes.
Assist in coordinating day-to-day operations to ensure effective and efficient delivery service.
Manage manual distribution of claims or workflow when automated systems are unavailable.
Track the completion and outcomes of assigned tasks within the team.
Investigate queue and reporting workflows for efficiency improvements and distribution opportunities.
Manage schedules, meetings, and communications, ensuring proper documentation and timely follow-ups.
Research historical performance to provide analytics on team outcomes.
Maintain departmental reports to increase claim monetization, improve quality, and identify revenue opportunities.
Analyze and maintain departmental reports to improve data quality, identify distribution opportunities, and manage workflow.
Provide ad hoc reports upon request.
Observe and analyze processes to identify inefficiencies and suggest improvements.
Recommend changes to systems and operations to optimize workflow efficiency.
Support project planning, track progress, and ensure deadlines are met, working closely with cross-functional teams.
Investigate queue and reporting workflows for efficiency improvements and distribution opportunities.
Assist with special projects, prioritizing and shifting focus as needed while maintaining daily workload.
Work closely with managers and coordinate with team leaders, and department heads to manage inventory and maintain distribution levels.
Facilitate feedback from team members and management and executive teams.
Present solutions and recommendations to management regularly.
Collaborate with management and executives to set departmental and organizational goals.
Assist peers and department heads in resolving issues or inquiries.
Assist with team inquiries and resolve operational issues to ensure department satisfaction.
Deliver reports to management and executives, providing insights into operational efficiency.
Train peers on established processes as needed.
Back up daily workflows for peers when required.
Support project planning, track progress, and ensure deadlines are met by working closely with cross-functional teams.
Observe, review, and analyze processes to identify inefficiencies and areas for improvement.
Recommend changes to systems and operations to improve workflow efficiency within the department.
Maintain accurate records, monitor performance metrics, and prepare operational reports for management.
Demonstrate the company’s core competencies and values in all activities.
Handle sensitive data responsibly due to the high-risk nature of the role.
Assist with other duties, responsibilities, and qualifications as assigned.
Ensure compliance with HIPAA regulations, company policies, and industry standards.
Ensure all operations conform to local, federal, and industry regulations.
Recognize that this is a high-risk role due to exposure to PHI (Protected Health Information) and ensure compliance with all relevant regulations.
Ensure that all activities comply with local, federal, industry, and company standards, including HIPAA regulations.
Maintain adherence to organizational policies and safety protocols.
Perform other duties as assigned to meet the needs of the organization.

Benefits

Medical (PPO & HDHP), dental and vision coverage
Pre-tax Savings Account (FSA & HSA)
Life & Disability Insurance
Paid Parental Leave
401(k) company match
Employee Stock Purchase Plan
Generous Paid Time Off -- accrued based on years of service
10 paid company holidays
Tuition reimbursement
Employee Assistance Program
Sick time benefits -- for eligible employees, one hour of sick time for every 30 hours worked, up to a maximum accrual of 40 hours per calendar year, unless the laws of the state in which the employee is located provide for more generous sick time benefits