Business Operations Specialist
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Job Description
Business Operations Specialist responsible for compliance and operational efficiency at Luminare Health. Collaborating with teams to analyze reports, enforce standards, and improve processes.
Responsibilities:
- Responsible for the maintenance, revision, and implementation of Policies and Procedures to ensure compliance with applicable regulatory standards and contractual obligations
- Prepare, develop and make recommendations by analyzing reports and operational data to support operational improvements and enforcement of established standards
- Work collaboratively with overall operations management team to develop operational efficiencies, maintain contractual requirements, and overall compliance of core operations is in conformity with various rules and regulations
- Conduct continual research of new and revised accreditation and regulatory standards applicable to CMS in collaboration with external PSERS vendors
- Maintain a database of regulatory requirements applicable to PSERS processes
- Responsible for the ongoing maintenance and revision of PSERS Division and Utilization Management Policy
- Acts as the Department Liaison for maintenance of required Regulatory Filings/Reports and CMS Inquiries
- Collect, analyze and report on key metrics inclusive of identifying trends, barriers, conducting root cause analysis when applicable and providing objective recommendations
- Recommend process improvements for every day operating procedures
- Assist with the ongoing analysis of the PSERS Program to identify opportunities for process improvement, reengineers processes to improve efficiencies and to ensure compliance
- Provide expertise in regulatory/accreditation issues/inquiries for all PSERS functional areas
- Maintain a positive and educational approach when interacting with both internal and external customers in explaining the Regulatory Compliance Program wants and needs
- Assist with the orientation of personnel and positively contribute to the ongoing networking of expertise with colleagues
- Compile information via data sources and provide back up support for system administration collecting, analyzing, and summarizing information.
- Work collaboratively with management team to work on identified trends and issues for short term and long term resolution, leveraging people, process, technology, and team communications/tools are updated.
- Promptly review Medicare Part A/D changes and determine impact to PSERS operations
- Share the information with operational team and assess impact, implementing changes as needed, to ensure proper tools and educational information is shared with front line team members or impacted individuals
- Review eligibility and customer service audits, as well as Medicare program audits, to assess steps needed to be taken to correct issues, report and respond to CMS.
Requirements:
- High School Diploma
- Minimum three to five years’ experience with insurance operations, business or technical experience specific to claims, customer service or enrollment
- Ability to work in a fast-paced, customer service & production driven environment
- Excellent verbal and written communication skills
- Ability to work effectively with employees/members, providers, and differing levels of co-workers and all levels of staff
- Ability to use common sense understanding to carry out instructions furnished in oral, written or diagram form
- Flexible; open to continued process improvement
- Self-directed individual who works well with minimal supervision
- Good leadership, organizational and interpersonal skills
- Ability to give direction and provide feedback
- Demonstrated critical thinking skills
- Ability to effectively deal with problems in varying situations and reach resolution
- Ability to learn new/proprietary systems, to adapt to various system platforms, and to effectively use MS Excel/Word
- Previous working knowledge of Medicare and CMS regulations.
Benefits:
- Health and wellness benefits
- 401(k) savings plan
- Pension plan
- Paid time off
- Paid parental leave
- Disability insurance
- Supplemental life insurance
- Employee assistance program
- Paid holidays
- Tuition reimbursement
- Other incentives
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