7 days left
- Employment Status
- Full Time
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.
ABOUT UCAREAt UCare, we deliver high-quality health coverage and services to help members of all ages maintain and improve their health. It's a big job that takes innovative ideas, strategic partnerships, and a commitment to doing the right thing. Above all, it takes a compassionate team that is dedicated to making a real difference in the lives of our members and our communities.WORKING AT UCAREWorking at UCare is more than just a career; it's a mission. A mission that defines us as professionals, unites us as an organization, and shapes how we interact with our members and each other. Our values of integrity, community, quality, flexibility, and respect permeate every aspect of our organization - from who we are and how we act, to what we do and how we do it. We owe our continued success to our employees who proudly embody our mission and values in everything they do. OPERATIONS ANALYST Position DescriptionThis position is responsible to design, develop and implement technical quality audit programs and monitor accuracy, compliance and effectiveness of production across Billing and Enrollment and other impacted areas such as Customer Services, Sales and Product. Develop, monitor and maintain Billing and Enrollment policies and procedures and step by steps in compliance with regulatory requirements across Medicare, Medicaid and Commercial (Exchange). Develop, monitor and provide feedback on performance during new employee onboarding and existing employee transition period. Assist with the development and presentation of UCare sponsored training programs specific to billing and enrollment functions. Also assist with vendor oversight of production materials and execution of changes and updates to support annual enrollment readiness for Medicare, Medicaid and Commercial. This position is instrumental in identification, development and deployment of continuous process improvement across the vendors and impacted departments specific to the billing and enrollment functions across all lines of business.This position is also responsible for coordinating and executing on internal audit activities and ensuring compliance with deliverable, regulatory compliance and required timelines.·Serve as a resource and mentor to billing and enrollment team in terms of quality audits. Design, develop and implement uniform departmental quality standards. Develop communication tools and protocols to share feedback and monitor quality audit and effectiveness. ·Develop and deliver feedback to billing and enrollment staff around performance, accuracy, adherence and effectiveness of production functions. Develop tools to measure effectiveness of quality audit program.·Collaborate with UCare departments and managers, Quality Analyst and Operations Analyst/Trainer; participate in the analysis, development, and delivery of quality auditing programs for specific to billing and enrollment.·Coordinate the review of billing and enrollment policies and procedures. Collaborate with billing and enrollment leaders to implement policies and procedures. Develop training and new quality metrics as appropriate to educate staff on new or revised policies and procedures.·Understand and accurately interpret member contracts (evidence of coverage), provider contracts, state and federal rules and regulations, UCare policies and procedures and provide training as appropriate. ·Understand and accurately interpret state and federal rules and regulations, UCare policies and procedures specific to the Billing and Enrollment functions and provide training or resource tools as appropriate. ·Co-Lead annual enrollment activities and readiness for Medicare, Medicaid and Commercial lines of business. Work across departments and vendors to define work effort, timelines and roles and responsibilities. Execute against complex and dynamic project plan to ensure regulatory compliance and terms and timelines are adhered too.·Design, develop and deploy annual quality audits program materials specific to annual enrollment activities and internal and external requirements.·Provide vendor oversight of specific vendors critical to success of adherence to annual enrollment activities for Medicare and Commercial lines of business (i.e. ikaSystems, HealthLogixs, Sungard, Wells Fargo, DHS, MNsure.)·Perform data gathering, root cause analysis, testing and performance trending across business processes. , Utilize process improvement tools and methodologies to assess the tools used by billing and enrollment (IKA, HealthLOGIX, Wells Fargo, Sungard, etc.). Develop and deliver training as appropriate due to system or process changes. ·Participate in internal and external audit activities with the Quality Analyst, GR, Compliance, Legal and other impacted areas. Responsible for gathering of requirements, data and reports in specified format and timelines.·Develop and maintain department policies and procedures consistent with the goals and objectives of the organization. Supplement policies and procedures with Step by Steps (SBS) including functional and process level instruction and illustration. Communicate changes in policies and procedures to team and management in a timely manner.·Update and maintain documentation on process improvement and process performance and share with managers and director.·Collaborate with Training to incorporate findings into individual and/or team training and development plan. ·Coordinate the implementation of compliance obligations specific to billing and enrollment. Develop and deliver department training on quality findings as appropriate.·Other projects and duties as assigned.EducationBachelor's Degree in business, training or industrial design; demonstrated experience may be considered in lieu of degree.Required ExperienceFive years' experience in a health plan or managed care environment. Three years' experience in design, development and delivery of technical training. Experience with adult learning principles. Knowledge of regulatory requirements for Medicare, Medicaid and Commercial - including internal and external audit prep and delivery of requested data. Experience in developing process improvement and quality assurance programs and subsequent development of ongoing training. Experience with vendor oversight and project management.Preferred ExperienceWorking knowledge of Medicare, Medicaid, commercial (individual) operational processes. Supervisory or team lead experience with specific background in providing work direction, staff training and coaching. Process improvement experience using Lean, Scrum or other process improvement methodology.THE UCARE DIFFERENCEUCare is proud to be a recognized Star Tribune Top Workplace for the 7th consecutive year. As a part of our collaborative team, you'll experience the rewards that come with helping others and seeing the positive results of your hard work. We value and respect each individual's ideas and contributions, and give you the freedom to grow both personally and professionally. We are centrally located, and offer onsite education, equipment and wellness resources, a myriad of volunteer activities, and a number of other rewards. If you're looking for a welcoming environment that celebrates what you have to offer, helps you build on your strengths, and gives you the opportunity to truly make a difference, we invite you to apply. As an Equal Opportunity/Affirmative Action Employer, we welcome and employ a diverse employee group committed to meeting the needs of UCare, our members, and the communities we serve.
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.