Operations Analyst Medicare

Are you passionate about driving quality and operational excellence in healthcare? Priority Health is seeking a detail-oriented and analytical Operations Analyst to play a critical role in enhancing our operational quality audit processes. In this position, you will go beyond standard audit criteria, uncovering new opportunities to improve accuracy, ensure compliance, and elevate our commitment to quality. From conducting MSP validations and analyzing complex data to collaborating with teams like billing, customer service, and compliance, your work will directly impact our ability to deliver exceptional service. If you're ready to use your expertise to identify quality concerns and drive meaningful improvements, this role is for you!

The Operations Analyst is responsible for identification of operational quality audit error criteria not included in current audits and within the scope of the operational quality audit team. This responsibility is accomplished through reviewing audit samples beyond the current auditing criteria to identify any quality concerns our current audits would not evaluate. When determined warranted findings are documented and evaluated to determine if they should be added to existing audits and what actions should be taken.

• Conduct MSP Validations: Perform comprehensive validations of Medicare Secondary Payer information through outbound calls to other insurance plans to ensure accurate premium calculations and compliance with federal regulations.
• Data Analysis: Analyze beneficiary data to identify any discrepancies or inconsistencies in Medicare Secondary Payer information. Report findings and take corrective actions as necessary.
• Regulatory Compliance: Stay updated with the latest Medicare regulations and guidelines. Ensure all validations and processes align with current federal requirements.
• Documentation and Reporting: Maintain thorough documentation of all validation activities. Prepare detailed reports for internal review and regulatory audits.
• Collaboration: Work closely with other departments, including billing, customer service, and compliance teams, to ensure seamless integration of MSP validation processes.
• Training and Support: Provide training and support to team members on MSP validation procedures and Medicare regulations. Act as a subject matter expert within the organization
• Executes monthly auditing functions to defined procedures. following standard documentation.
• Maintains, improves and adds to auditing procedures.
• Seeks out industry and organizational knowledge to validate auditing samples and identify quality concerns.
• Creates analysis of quality concerns.
• Supports special projects and other auditing functions.

Required

• High School diploma or equivalent
• 2 years of relevant experience implementing successful, organization-wide operational quality assessment
• 3 years of relevant experience Managed Care

Preferred

• Bachelor's Degree or equivalent in a health-related degree or equivalent experience

As a team member at Corewell Health, you will play an essential role in delivering personalized health care to our patients, members and our communities. We are committed to cultivating and investing in YOU. Our top-notch teams are comprised of collaborators, leaders and innovators that continue to build on one shared mission statement - to improve health, instill humanity and inspire hope. Join a nationally recognized health system with an ambitious vision of continued advancement and excellence.

• Comprehensive benefits package to meet your financial, health, and work/life balance goals. Learn more here.

• On-demand pay program powered by Payactiv

• Discounts directory with deals on the things that matter to you, like restaurants, phone plans, spas, and more!

• Optional identity theft protection, home and auto insurance, pet insurance

• Traditional and Roth retirement options with service contribution and match savings

• Eligibility for benefits is determined by employment type and status

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Corewell Health is committed to providing a safe environment for our team members, patients, visitors, and community. We require a drug-free workplace and require team members to comply with the MMR, Varicella, Tdap, and Influenza vaccine requirement if in an on-site or hybrid workplace category. We are committed to supporting prospective team members who require reasonable accommodations to participate in the job application process, to perform the essential functions of a job, or to enjoy equal benefits and privileges of employment due to a disability, pregnancy, or sincerely held religious belief.

Corewell Health grants equal employment opportunity to all qualified persons without regard to race, color, national origin, sex, disability, age, religion, genetic information, marital status, height, weight, gender, pregnancy, sexual orientation, gender identity or expression, veteran status, or any other legally protected category.

An interconnected, collaborative culture where all are encouraged to bring their whole selves to work, is vital to the health of our organization. As a health system, we advocate for equity as we care for our patients, our communities, and each other. From workshops that develop cultural intelligence, to our inclusion resource groups for people to find community and empowerment at work, we are dedicated to ongoing resources that advance our values of diversity, equity, and inclusion in all that we do. We invite those that share in our commitment to join our team.

You may request assistance in completing the application process by calling 616.486.7447.