Description
How you will make an impact:
Responsible for process improvement projects to increase the quality and performance of a business unit.
Primary duties may include, but are not limited to:
- Work closely with company delegated vendors and internal/external customers to deliver efficient and effective solutions to issues at hand.
- Work closely with internal customers to help triage and resolve provider and member complaints, quality of care issues and/or initiatives that arise.
- Communicate in a professional, consistent and coherent matter (written, verbally and in-person behavior as applicable).
- Work environment is “fast-paced” and requires a high sense of urgency with the ability to adapt accordingly given situations encountered.
- Must collaborate to create “win-win” outcomes with both internal and/or external teams.
- Identifies areas at risk and implements improvements with the appropriate participation of involved parties.
- Develops recommendations for changed/new processes. Documents current work flow.
- Coordinates to obtain consensus and commitment among affected parties.
- Coordinates implementation and monitors post-implementation.
- Makes necessary adjustments as needed.
- May act as lead in providing direction to less experienced associates in the departments.
- Provides process improvement methodology, coaching and training to associates and team members who are participating in process improvement projects.
- Collaborates with cross-functional teams in the identification, research and implementation of process improvements.
- Leads projects of significant scope.
- Manages internal and external process improvement projects with team members who work across regional and enterprise wide organizational structures and with external parties (providers and trade organizations) to formulate consensus on improvements and to implement internal and external systems, policies and procedures.
- Handle large data sets and the use of SQL querying tools/techniques to data-mine and present information in a manner to best facilitate decision making and/or troubleshooting issues
- Perform weekly reconciliation analyses on encounters submitted into the health plan to understand timeliness and completeness of such submissions; along with comparison analyses to CDJ/CDR files to understand completeness of encounters submitted.
- Work closely with vendors and related parties to reach results needed.
Minimum Requirements:
- Requires a BA/BS in a related field and minimum of 5 years process improvement or project management experience; or any combination of education and experience, which would provide an equivalent background.
Preferred Skills, Capabilities and Experiences:
- Healthcare experience preferred, especially from the payor side and/or working with delegated vendors.
- Experience with SQL required and Microsoft Access highly preferred.
- Proficiency with MS Excel, MS PowerPoint, SharePoint, Talabeau, Power BI and its uses for data analytics. Excellent written and verbal communications.
- Good analytical and problem solving skills. Familiarity with CMS and FL AHCA encounter submission protocols desired.
- Attention to detail and passion for accuracy.
- Good interpersonal skills and comfortable presenting, moderating and leading meetings.
- Six Sigma Black Belt certification or related process improvement certification preferred.
If this job is assigned to any Government Business Division entity, the applicant and incumbent fall under a 'sensitive position' work designation and may be subject to additional requirements beyond those associates outside Government Business Divisions. Requirements include but are not limited to more stringent and frequent background checks and/or government clearances, segregation of duties principles, role specific training, monitoring of daily job functions, and sensitive data handling instructions. Associates in these jobs must follow the specific policies, procedures, guidelines, etc. as stated by the Government Business Division in which they are employed.
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. A Fortune 20 company with a longstanding history in the healthcare industry, 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 in certain patient/member-facing roles 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 2022, has been ranked for five years running as one of the 2023 World’s Most Admired Companies by Fortune magazine, and is a growing Top 20 Fortune 500 Company. To learn more about our company and apply, please visit us at careers.ElevanceHealth.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 ability@icareerhelp.com for assistance.