Under minimal supervision from the Quality Remediation leadership team, provides high level support by coordinating System Business Process audit and process improvement functions including, but not limited to supporting the Vice President and departmental leadership tracking day-to-day System Business Process operations to support the corporate strategies surrounding recoveries audits. Incumbent is responsible for trend analysis of competitive, economic, statistical, and industry information pertaining to Quality Remediation efforts. Position develops materials, presentations, and reports by working directly with members of the department leadership team and helping to drive strategies and quality improvement.
Shares techniques and information with System Business Process leadership to recommend and drive decisions and/or to improve Health Plan operations. Educates and assists others with complex tasks and promotes professional communications, sharing ideas with other teams and departments in an effective manner.
* Coordinates audit functions including, but not limited to tracking day-to-day Client Provider Services operations.
* Maintain the department's database to track and trend audit findings which will be used to make decisions for operational improvements.
* Create reports that compile the data into simple and understandable format
* Interpret data, analyze results using statistical techniques and provide ongoing reports
* Acquire data from primary or secondary data sources and maintain databases/data systems
* Participates in problem-solving and investigation, analyses, special projects, and research projects as requested.
* Develops materials, presentations, and reports by working directly with members of the department leadership team in coordinating and driving the strategies and quality remediation efforts.
* Manages departmental recovery ad-hoc requests on behalf of management, prioritizing requests to ensure timely and accurate completion.
* Updates Client Provider Services staff on progress and expected time frames for deliverables and works with both internal and external customers to ensure higher quality, more insightful analysis and products to meet the customer's needs.
* Identifies and defines new process improvement opportunities
* Contributes to team effort by accomplishing related results as needed
* Maintains quality service by establishing and enforcing organization standards
* Create compelling reports using database web analytics and social graph data
* Develop and implement databases, data collection systems, data analytics and other strategies that optimize statistical efficiency and quality
* Directs and develops information-sharing processes within the department to report status and relevant information to executive level management in a clear, concise, and professional format while obtaining insight from staff. Makes detailed presentations to project teams, department heads, and all levels of management when appropriate.
* Develops the dashboard metrics to support the divisional plan. Identifies and analyzes trends, patterns, and exceptions of competitive, economic, statistical, and industry information. Based on these analyses, recommends changes to process and practice and presents these recommendations to management.
* Works with department leadership to develop tools and utilize computer applications to track and trend information and to drive efficiency within the department, especially those that involve complex technical development or are resource-intensive.
* Develops codes for database access, modifications and constructions including stored procedures
* Develops SQL statements for data collection via AQT software
* Trains and mentors new/junior staff in data collection and advanced analytical techniques
* Plan, coordinate and implement security measures to safeguard information in departments' database against accidental or unauthorized damage, modification or disclosure
* Identifies opportunities for automating routine processes where appropriate and takes the initiative to implement them.
* Identify, analyze and interpret trends or patterns in complex data set
* Work with management to prioritize business information and needs
* Develop and maintain internal procedures for the various functionalities of the Client Provider Service databases
* Consistently demonstrates high standards of integrity by supporting the Lifetime Healthcare Companies' mission and values, adhering to the Corporate Code of Conduct, and Leading to the Lifetime Way values and beliefs.
* Maintains high regard for member privacy in accordance with the corporate privacy policies and procedures.
* Regular and reliable attendance is expected and required.
* Performs other functions as assigned by management.
Level II ? In addition to Level I responsibilities:
* Create and implement databases for inter-departmental and cross divisional use
* Develop code, analyzes, researches and resolve database system issues
* Creates and maintains application documentation
* Create and reviews Technical specs for complex changes
* Discover and manipulate data using SAS
* Communicates and work with team members/Business to understand requirements and identify application impacts
* Assists customers in envisioning and defining effective technical system designs in order to meet requirements
* Creates and executes appropriate unit test cases
* Review databases, data collection systems, data analytics and other information created by level I staff for accuracy
* Leads and directs the work Level I staff
* Become liaison between System Business Process staff and outside departments to develop multi divisional databases that will be utilized by various departments
* Maintain high regard for Client Provider Services staff privacy in accordance with departmental standards
* Organizes inter departmental meetings in order to develop and/or maintain databases that will be utilized to the fullest extent for all staff
* Monitors trends from databases to continually inform management and help develop procedures for staff for remediation purposes
* Assists in mentoring and training of level II staff to gain experience and expand technical skill set.
* Creates status, audit and metrics reports on a daily, weekly, monthly and annual basis
Note of Classification
We include multiple levels of classification differentiated by demonstrated knowledge, skills, and the ability to manage increasingly independent and/or complex assignments, broader responsibility, additional decision making, and in some cases, becoming a resource to others. In addition to using this differentiated approach to place new hires, it also provides guideposts for employee development and promotional opportunities.
* Bachelor's degree in Business Administration or Finance with a minimum of seven years of progressive experience in financial analysis, cost impact, and policy analysis to include data modeling, or health care delivery within a medical setting. In lieu of degree, twelve years of related business experience required.
* Advanced knowledge of statistical concepts and exceptional analytical and problem solving skills
* Advanced analytic abilities combined with proven capabilities for completing projects with minimum supervision.
* Advanced level PC skills including proficiency in Microsoft Office Products (EXCEL, Word, Access, etc.).
* Advanced knowledge of the health care system and experience working with physician or hospital claims data required
* Strong knowledge of and experience with reporting packages (Business Objects,) and database (SQL)
* In-depth understanding of the functionality and use of software products which support national health insurance coding standards (e.g. Claim Check).
* Demonstrated effective presentation skills to effectively and clearly interface with all levels of management and clearly exemplify current situation as well as present recommendations for change.
* Ability to work independently, as well as on intra- and inter-departmental teams.
* Experience with business intelligence and analytics software (e.g. SAS, Cognos, and AQT), relational database and database management preferred.
* High degree of initiative, proactive attitude, and commitment to teamwork.
* Demonstrated ability to generate high quality, reconciled data for all analyses.
* Demonstrated project management and organization skills.
* Demonstrated ability to effectively interact with internal and external customers with particular strength translating user information needs into information for use in quality audits and metrics reporting.
* Adaptable to constant organizational/environmental change and rapidly changing priorities.
* Willingness to solicit and respond to customer feedback
* Ability to use inductive reasoning
* Ability to determine the interrelationships between solutions and requirements
* Maintains data dictionary
* Substantial knowledge and experience in health systems operations including knowledge of financial payment and risk arrangements, reimbursement methodologies, and coding conventions for all lines of business including governmental and commercial products.
* Strong analytical skills with the ability to collect, organize, analyze and disseminate significant amounts of information with attention to detail and accuracy.
* Excellent, professional oral and written communication skills with aptitude for communicating to a variety of audiences.
* Superior project management skills and organization skills with proven ability to manage multiple projects with competing deadlines to successful completion.
* Maintain professional and technical knowledge by attending educational workshops, reviewing professional publications, establishing personal networks, benchmarking state-of-the-art practices; participating in professional societies
Incudes all of the required qualifications for levels I and II and:
* Bachelor's degree in Business Administration or Finance with a minimum of nine years of related business experience required. In lieu of degree, sixteen years of related business experience required.
* Master's degree highly preferred
* Minimum of nine years of progressive experience in financial analysis, cost impact, and policy analysis to include data modeling, or health care delivery within a medical setting.
* Expert knowledge of statistical concepts and extraordinary analytical and problem solving skills
* Expert analytical abilities and capable of developing team projects to enhance the Client Provider Service team
* Expert level PC skills including enhanced knowledge within the Microsoft Office Suite
Travel to all regions is required.
The Lifetime Healthcare Companies aims to attract the best talent from diverse socioeconomic, cultural and experiential backgrounds, to diversify our workforce and best reflect the communities we serve.
Our mission is to foster an environment where diversity and inclusion are explicitly recognized as fundamental parts of our organizational culture. We believe that diversity of thought and background drives innovation which enables us to provide leading-edge healthcare insurance and services. With that mission in mind, we recruit the best candidates from all communities, to diversify and strengthen our workforce.
OUR COMPANY CULTURE:
Employees are united by our Lifetime Way Values & Behaviors that include compassion, pride, excellence, innovation and having fun! We aim to be an employer of choice by valuing workforce diversity, innovative thinking, employee development, and by offering competitive compensation and benefits.
In support of the Americans with Disabilities Act, this job description lists only those responsibilities and qualifications deemed essential to the position.