Billing and Enrollment Quality Specialist Sr.
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Health Care that Starts with You!
Join a truly mission-driven organization! Independent, nonprofit UCare is recognized as one of the Minnesota???s leading health plans. We provide more than 225,000 members across Minnesota and western Wisconsin with the health coverage plans and services they need to maintain and improve their health. The innovative coverage we create makes a difference for Medicare-eligible individuals, individuals and families enrolled in Minnesota Health Care Programs, such as MinnesotaCare and Medical Assistance, and disabled adults with special health care needs. UCare is growing in size, membership, products, geographic coverage, and employees. We???re an organization that???s going places. Be part of a team that cares about you, be part of UCare.
The Billing and Enrollment Quality Specialist Sr. will develop, monitor, and maintain the Enrollment and Billing policies and procedures related to quality assurance in compliance with all regulatory requirements and provide feedback on individual performance. Collect data and provide a comprehensive approach to analyzing and reporting data related to quality monitoring. Serve as a resource to the Training & Development Coordinator in the development, implementation, assessment, evaluation and reporting of quality improvement activities for Billing and Enrollment. Ensure that overall quality monitoring reporting activities are in compliance with state, federal and regulatory requirements. Provide accurate monthly reporting to the Director and Managers. Provide trend reporting to department leadership and training & development coordinator. Specific duties and responsibilities include:
- Collaborate with department leaders to design data collection processes, and assist in developing and implementing a method to assess data accuracy and completeness.
- Responsible for data analysis in support of departmental performance improvement.
- Develop, maintain, and audit Billing and Enrollment curriculum and resource materials.
- Prepare, conduct and analyze 10% user audits (or required/requested percentage) to ensure staff’s technical competence. Provide feedback and follow up support as needed to Training & Development Coordinator.
- Complete the initial findings report for end-to end and distribute to appropriate departments. Complete system data requests as needed upon final approval of audit.
- Support the Training & Development Coordinator on projects as needed.
Five or more years experience in Health Plan and/or billing and enrollment processing. Functional experience working with and understanding of Medicaid and Medicare regulations and requirements.
Billing and Enrollment quality assurance experience. Experience working with CMS/DHS regulations. High school graduate or equivalent required. Four year degree in accounting, business or health related field or liberal arts preferred, relevant work experience considered in lieu of degree.
The knowledge, skills, and abilities required to be successful in this role include:
- Proven problem solving skills
- Effective written and oral communication skills
- Demonstrated organizational skills
- Ability to meet deadlines
- Ability to maintain confidentiality and guidelines
Enter a highly collaborative environment where people are truly engaged, and feedback is valued. You???ll enjoy a competitive salary and benefits, as well as a host of other perks, including a nationally recognized wellness program, and a bright, open, award-winning office space in Northeast Minneapolis???just minutes from major freeways and retail centers.
At UCare, we welcome and employ a diverse employee group committed to meeting the needs of UCare, our members, and the communities we serve.