Job FamilyClaimsJob Brief
Service Center Audit Lead will take a hands on approach in handling, managing, and finding resolutions to operational issue within the service center.
ExemptABOUT THE POSITION
We are currently seeking a dynamic Service Center Audit Lead
to join our team at our office in Cypress,
CA. The Service Center Audit Lead will assist in the development and coordination of all business operations activities. Serves as an expert resource and facilitates business operations between service center departments. Service Center Audit Lead will take a hands on approach in handling, managing, and finding resolutions to operational issue within the service center. Service Center Audit Lead resolves business issues/problems using appropriate analytic tools and business processes to ensure quality, cost effectiveness and timeliness within the parameters of contractual and regulatory requirements and mandates. Position Responsibilities:
- Analyzes and proposes solutions to operating and system hurdles, client requirements and program design needs.
- Provides clear communication of the overall scope, resources requirements, and overall deliverables to management and all key stakeholders.
- Identifies business needs and determining solutions to business problems.Solutions can consist of process improvement, organizational change, strategic planning and policy development and information system
- Lead cross functional process improvement initiatives and continually explore new avenues for improving business and operational processes, workflows, and KPI's for both clinical and non- clinical aspects for overall quality of service/output.
- Develop the approach and method to define and solve problems through quantitative analysis.
- Collects and analyzes data to evaluate operational difficulties and makes recommendations to solve problems
- Serves as the primary liaison to the Business Intelligence, Application Development and Electronic Data Interchange departments.
- Collects and refines appropriate data for analysis, provides summations, observations and insights to address utilization trends and presents findings to Senior Management, AVP, the client and other stakeholders.
- Utilizes data and analytic information available when making decisions, conducting comparative analysis or otherwise evaluating impact, performance and cost.
- Project manages cross-department initiatives from concept to launch and through to closeout of project/initiative.
- Identifies, tracks and monitors staff training needs, as well as operational streamlining opportunities.
- Proposes solutions to business issues/problems utilizing appropriate analytic tools and business processes (including information systems) to ensure quality, cost effectiveness, timeliness, with awareness of contractual and regulatory requirements/mandates
- Participate actively in internal cross departmentalmeetings and all mandatory company meetings
- Understands and distills various projects internally and externally as needed
- Trends or issues and presents findings to management, the client and other stakeholders.
- Adheres to all Beacon policies and procedures and standards of operations.
- Completes all required and assigned trainings.
- Performs annual staff reviews and establish individual/team goals for development.
- Motivates team members to reach department goals and objectives.
- Attends all mandatory company or department meetings.
- Displays a positive, constructive, and helpful demeanor that is conducive to a safe and respectful work environment.
- Acts as a mentor to team members by leading by example and guiding with a sense of integrity and team work.
- Meets regularly with team members for one on ones and staff meetings.
- Identifies opportunities for staff improvement, high performing team members, and training needs of team members.
- Partners with management to identify areas of opportunity within department and makes improvements on processes, culture, or work environment.
- Acts as a liaison between staff, management, and other functional departments for consistent improvements of functions and work flow.
- Identify misconduct and finds resolution and escalate to Human Resources.
- Travel to all company sponsored events, trainings, and locations based on business needs.
- Performs special projects and other duties as assigned and required.
: Associates Degree required; Bachelor's Degree preferredRelevant Work Experience:
1-2 years' working in managed healthcare fieldLicensure:
N/AKnowledge, Skills & Abilities
- Experience or knowledge in Claims, Network Operations, Credentialing, and Contracting preferred
- Project Management education/training/or PMP certification desirable
- Experience in successfully managing multiple projects simultaneously from concept through close out of project
- Strong interpersonal skills and good written and verbal communication skills.
- Advanced computer skills required, including working knowledge of MS Office: Word, Excel, and PowerPoint.
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Beacon Health Strategies, LLC., a Beacon Health Options company, is proud to be an Equal Opportunity Employer as well as a Drug Free Work Environment. EOE/M/F/Veterans/Disabled
AAP Reporting Location:CA - Cypress
ID (Req #):53357
FTE Status:Full Time
Schedule:8:30AM -5:00PM, MON-FRI