Remote - Operations Regulatory Specialist II (Hybrid Location) - R12948 at CareSource | Torre
Remote - Operations Regulatory Specialist II (Hybrid Location) - R12948
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CareSource

Remote - Operations Regulatory Specialist II (Hybrid Location) - R12948

CareSource
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Full-time

Legal agreement: Employment

Compensation
USD62.7k - 100k/year
location_on
Remote (for United States residents)
Shared by
Julien PETIT
 about 1 month ago

Responsibilities

The Operations Regulatory Specialist II provides analytical support and leadership for key internal Operations projects and partners with the Operations departments to ensure all regulatory and compliance deliverables are met. This position will work Tues/Thurs o office and remote the other days.Essential FunctionsRepresent operations on cross-functional project work teamsSubmit, monitor and prioritize IT tickets for the operations departmentsReview special projects and identify issue trends and potential resolutionsAssist with reporting and processes that are regulatory related and tied to state issues deadlinesAssist with the development, drafting and review of P&P’s and job aides for OperationsAssist in educating/training Business Partners on operations functions.Research and resolve provider claim issues and escalations by analyzing system configuration, payment policy, and claims data when requested by CompliancePerform analysis of all claims data to provide decision support to Claims management team in relation to regulatory requestsIdentify and quantify data issues within Claims and assist in the development of plans to resolve data issuesPartner and collaborate with Operations Business Owners to ensure all audit and regulatory deliverables are met accurately and on time. These deliverables may include:Documentation gathering – i.e. review of Standard Operating Procedure and/or Policy and Procedure to the audit/inquiry requirementsAudit Universe monitoring and/or creation – collaboration with IT and the Business Owners to validate the accuracy of the data and formatting of the final report for submissionPrepare Operations Business Owners for live questions and answers with the state regulators or auditorsTrack and assist with remediation efforts for Corrective Action Plans related to all audit findingsEnsure the timeliness submission of the Regulatory Reporting required by the state and federal agencies for OperationsTrack all Compliance required training on a yearly and new hire basis for OperationsAssist with all readiness activities in relation to implementation of a new line of business for OperationsPerform any other job-related instructions, as requestedEducation And ExperienceBachelor’s degree or equivalent years of relevant work experience requiredMinimum of two (2) years of healthcare operations environment is requiredRegulatory and/or compliance experience is preferredCompetencies, Knowledge And SkillsAdvanced level experience el and PowerPointData analysis and trending skillsDemonstrated understanding of claims operations specifically related to managed careAdvanced knowledge of coding and billing processes, including CPT, ICD-9, ICD-10 and HCPCS codingAbility to work independently and within a team environmentAttention to detailFamiliarity of the healthcare fieldCritical listening and thinking skillsNegotiation skills/experienceStrong interpersonal skillsProper grammar usageTechnical writing skillsTime management skillsStrong communication skills, both written and verbalCustomer service orientationDecision making/problem solving skillsLicensure And CertificationNoneWorking ConditionsGeneral office environment; may be required to sit or stand for extended periods of timeCompensation Range$62,700.00 - $100,400.00 CareSource takes into consideration a combination of a candidate’s education, training, and experience as well as the position’s scope and complexity, the discretion and latitude required for the role, and other external and internal data when establishing a salary level. may qualify for a bonus tied to company and individual performance. We are highly invested in every employee’s total well-being and offer a substantial and comprehensive total rewards package.Compensation TypeSalaryCompetenciesFostering a Collaborative Workplace Culture - Cultivate Partnerships - Develop Self and Others - Drive Execution - Influence Others - Pursue Personal Excellence - Understand the BusinessThis job description is not all inclusive. CareSource reserves the right to amend this job description at any time. CareSource is an Equal Opportunity Employer. We are dedicated to fostering an environment of belonging that welcomes and supports individuals of all backgrounds.
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