REMOTE - Operations Specialist II - R13119

Job Summary

The Operations Specialist II provides analytical support and leadership for projects impacting Claims and key internal Claims projects.

Essential Functions

• Represent claims on cross-functional project work teams
• Submit, monitor and prioritize IT tickets for the Claims department
• Review special projects and identify issue trends and potential resolutions
• Aid with Onbase reporting and processes
• Develop and draft P&P’s and job aides for Claims
• Aid in training claims staff on claims processing policy and procedures
• Aid in educating/training Business Partners on claims functions
• Research and resolve provider claim issues and escalations by analyzing system configuration, payment policy, and claims data
• Perform analysis of all claims data to provide decision support to Claims management team
• Identify and quantify data issues within Claims and assist in developing plans to resolve data issues
• If assigned to Research and Resolution team:
• Represent Claims Department at requested provider calls and visits
• Provide feedback and/or face-to-face interaction with providers for claims research and resolution
• Responsible for research and resolution of claims issues for all assigned provider inquiries and submissions
• Responsible for managing provider issues adhering to Workflow processes and tools (Facets and Onbase)
• Provide input for claims business requirements, testing processes and implementation tasks and plans

Education and Experience

• Bachelor’s degree or equivalent years of relevant work experience required
• Minimum of two (2) years of healthcare claims environment is required

Competencies, Knowledge and Skills

• Advanced level experience in Microsoft Word, Excel and PowerPoint
• Data analysis and trending skills
• Demonstrated understanding of claims operations specifically related to managed care
• Advanced knowledge of coding and billing processes, including CPT, ICD-9, ICD-10 and HCPCS coding
• Ability to work independently and within a team environment
• Attention to detail
• Familiarity of the healthcare field
• Critical listening and thinking skills
• Negotiation skills/experience
• Strong interpersonal skills
• Proper grammar usage
• Technical writing skills
• Time management skills
• Strong communication skills, both written and verbal
• Customer service orientation
• Decision making/problem solving skills

Licensure and Certification

• None

Working Conditions

• General office environment; may be required to sit or stand for extended periods of time

Compensation Range

• $62,700.00 - $100,400.00

Compensation Type

• Hourly

Competencies

• Fostering a Collaborative Workplace Culture
• Cultivate Partnerships
• Develop Self and Others
• Drive Execution
• Influence Others
• Pursue Personal Excellence
• Understand the Business

Working Conditions

• General office environment; may be required to sit or stand for extended periods of time

Compensation Type

• Hourly

Compensation Range

• $62,700.00 - $100,400.00

Compensation Type

• Hourly

Compensation Range

• $62,700.00 - $100,400.00

Compensation Type

• Hourly

Compensation Range

• $62,700.00 - $100,400.00

Compensation Type

• Hourly

Compensation Range

• $62,700.00 - $100,400.00

Compensation Type

• Hourly

Compensation Range

• $62,700.00 - $100,400.00

Compensation Type

• Hourly

Compensation Range

• $62,700.00 - $100,400.00

Compensation Type

• Hourly

Compensation Range

• $62,700.00 - $100,400.00

Compensation Type

• Hourly

Compensation Range

• $62,700.00 - $100,400.00

Compensation Type

• Hourly

Compensation Range

• $62,700.00 - $100,400.00

Compensation Type

• Hourly

Compensation Range

• $62,700.00 - $100,400.00

Compensation Type

• Hourly

Compensation Range

• $62,700.00 - $100,400.00

Compensation Type

• Hourly

Compensation Range

• $62,700.00 - $100,400.00

Compensation Type

• Hourly

Compensation Range

• $62,700.00 - $100,400.00

Compensation Type

• Hourly

Compensation Range

• $62,700.00 - $100,400.00

Compensation Type

• Hourly

Compensation Range

• $62,700.00 - $100,400.00

Compensation Type

• Hourly

Compensation Range

• $62,700.00 - $100,400.00

Compensation Type

• Hourly

Compensation Range

• $62,700.00 - $100,400.00

Compensation Type

• Hourly

Compensation Range

• $62,700.00 - $100,400.00

Compensation Type

• Hourly

Compensation Range

• $62,700.00 - $100,400.00

Compensation Type

• Hourly

Compensation Range

• $62,700.00 - $100,400.00

Compensation Type

• Hourly

Compensation Range

• $62,700.00 - $100,400.00

Compensation Type

• Hourly

Compensation Range

• $62,700.00 - $100,400.00

Compensation Type

• Hourly

Compensation Range

• $62,700.00 - $100,400.00

Compensation Type

• Hourly

Compensation Range

• $62,700.00 - $100,400.00

Compensation Type

• Hourly

Compensation Range

• $62,700.00 - $100,400.00

Compensation Type

• Hourly

Compensation Range

• $62,700.00 - $100,400.00

Compensation Type

• Hourly

Compensation Range

• $62,700.00 - $100,400.00

Compensation Type

• Hourly

Compensation Range

• $62,700.00 - $100,400.00

Compensation Type

• Hourly