8 Manager - Operations (Business Configuration Quality) Jobs in Mason, OH
EyeMed Vision Care is Hiring a Manager - Operations (Business Configuration Quality) Near Mason, OH
Position:Full-Time
Total Rewards: Benefits/Incentive Information
- Lead projects to enhance the audit controls of the Provider Network and Agreement Maintenance (PNAM) application.
- Lead the Business Configuration Annual Soc1 Controls and Managed Vision Care Revenue Quality Audits, responsible for providing the required evidence to support the controls throughout the review process.
- Collaborate with Business Configuration leaders to implement best practices for the audit and quality control of configuration.
- Perform daily quality assurance checks on configuration data as well as lead quality projects for data provider network and agreement configuration.
- Develop an end-to-end audit process for contract acceptance to network/agreement assignment, identifying governance reports that monitor the contract accepted matches the provider assignment.
- Provide assessment, analysis, and troubleshooting of potential data set up issues using SQL Queries to pull data from the system.
- Collaborate with IT on enhancements of automated solutions to deliver improved quality program processing.
- Responsible for identifying, defining, and driving enhancements in audit tools and processes to improve production team performance.
- Oversee and monitor established Performance Guarantees (PGs) for Business Configuration; monitoring and maintenance of PG Performance to ensure production is completed within goal and on time.
- Develop and maintain Quality Key Performance Indicator metrics for agreement, network, and fee schedule errors.
- Create training documentation and deliver training to other team members on auditing processes.
- Perform Business Configuration product, network, and agreement data cleanup activities.
- Perform and resolve network and agreement configuration questions/issues sent to the Business Configuration team.
- Maintain relationships with Account Managers, and Provider teams to develop a cohesive cross functional, results driven working environment.
- Coordinate and participate in cross-functional team activities for issue resolution.
- Recommend process and system enhancements to drive improvements.
- Bachelor’s degree in Business, or related field, or equivalent work experience
- 5 years’ experience health plans benefit, network, and agreement configuration.
- Previous experience in managing and developing teams
- 2 years’ experience writing basic SQL queries.
- Excellent analytical and problem-solving skills
- Strong communication and interpersonal skills
- Ability to manage multiple complex assignments at once.
- Experience in Operations in the Healthcare industry.
- Experience understanding claim adjudication for member and provider reimbursements.
- Experience with Facets platform using Claims, Provider, Network, Product Benefit Configuration
- Knowledge of Medicare and Medicaid programs
Job Summary
Full Time
Retail
$114k-140k (estimate)
04/17/2024
06/15/2024
eyemed.com
MASON, OH
200 - 500
1988
MANUEL PEREZ
<$5M
Retail
Related Companies
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