Remote Position in IngenioRX Locations.
Build the Possibilities. Make an extraordinary impact.
The Process Expert II supports the Regional SME for IngenioRx Medicaid Lock-In team. Leads all efforts related to lock activities for markets within the assigned region. Manages and oversees updates and new implementations while overseeing the monthly identification process and letter process. As well as interacts with: Regional Directors for the Medicaid Operations, regional Pharmacist Program/Account Managers, health plans and other internal and external departments.
How you will make an impact:
- Research operations workflow problems and system irregularities; develops tests, presents process improvement solutions for new systems, new accounts and other operational improvements; develops and leads project plans and communicates project status.
- Work closely with health plans, State, Clinical SMEs, Regulatory and Process Expert Sr. to implement contract changes.
- Submit and track Regulatory report request for assigned markets E2E.
- Submit and track collaterals for assigned markets E2E.
- Create and/or update training and educational materials (as needed).
- Maintain clean and accurate program shared drive and SharePoint site at all times.
- Process request tools, CMT, and email requests promptly and accurately.
- Weekly status reporting Ensure seamless operational coordination of day-to-day activities.
- Triage and track new requests Gather data needed for quarterly and annual submissions.
- Planning and Requirements Design and Development SIT & UAT coordination Readiness and Implementation Post Go-Live validation.
- Requires a BA/BS and minimum of 5 years’ experience in business analysis, process improvement, project coordination in a high-volume managed care operation (claims, customer service, enrollment and billing); or any combination of education and experience, which would provide an equivalent background.
Preferred Skills, Capabilities and Experiences:
- Ability to analyze workflows, processes, supporting systems and procedures and identifying improvements strongly preferred.
- Pharmacy experience is a plus.
- Compliance experience a plus.
- For URAC accredited areas, the following professional competencies apply: Associates in this role are expected to have strong oral, written and interpersonal communication skills, problem-solving skills, facilitation skills, and analytical skills.
Please be advised that Elevance Health only accepts resumes from agencies that have a signed agreement with Elevance Health. Accordingly, Elevance Health is not obligated to pay referral fees to any agency that is not a party to an agreement with Elevance Health. Thus, any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health.
Be part of an Extraordinary Team
Elevance Health is a health company dedicated to improving lives and communities – and making healthcare simpler. Previously known as Anthem, Inc., we have evolved into a company focused on whole health and updated our name to better reflect the direction the company is heading.
We are looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve. You will thrive in a complex and collaborative environment where you take action and ownership to solve problems and lead change. Do you want to be part of a larger purpose and an evolving, high-performance culture that empowers you to make an impact?
We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few.
The health of our associates and communities is a top priority for Elevance Health. We require all new candidates to become vaccinated against COVID-19. If you are not vaccinated, your offer will be rescinded unless you provide – and Elevance Health approves – a valid religious or medical explanation as to why you are not able to get vaccinated that Elevance Health is able to reasonably accommodate. Elevance Health will also follow all relevant federal, state and local laws.
Elevance Health has been named as a Fortune Great Place To Work in 2021, is ranked as one of the 2021 World’s Most Admired Companies among health insurers by Fortune magazine, and a Top 20 Fortune 500 Companies on Diversity and Inclusion. To learn more about our company and apply, please visit us at careers.ElevanceHealthinc.com. Elevance Health is an Equal Employment Opportunity employer and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws. Applicants who require accommodation to participate in the job application process may contact firstname.lastname@example.org for assistance.