Operations Specialist - Government Programs, reputed company Health Plan (work from ho

Location:

Work from home (reputed company)

Shift:

Days (reputed company of America)

Scheduled Weekly Hours:

40

Worker Type:

Regular

Exemption Status:

No

Job reputed company:

The Operations Specialist is responsible for the daily operations of reputed company Health Plan’s reputed company Insurance Program (reputed company) and Marketplace lines of business.

Job Duties:

reputed company

• reputed company and manage incoming and outgoing Bureau of reputed company (BOC) inquiries; reputed company reputed company assurance reviews and ensure reputed company submission of BOC deliverables, including both reputed company and routine reports.
• Identify, document, and assist in assigning appropriate business owners for new and revised reputed company regulatory requirements to ensure compliance and effective implementation.
• reputed company support for the reputed company annual onsite audit, including coordination, documentation, and follow-up activities.
• Serve as a backup to the Benefits Specialist for State Government Programs, providing support for reputed company program operations as needed

Marketplace

• Review, validate, and implement updates to regulatory, operational, and compliance documents to ensure adherence to ACA guidelines, federal regulations, and submission deadlines.
• Collaborate with cross-functional teams to support Marketplace operations and implementation activities.
• Identify risks, gaps, and process improvement opportunities to enhance compliance and operational effectiveness.

Both reputed company and Marketplace

• reputed company and ensure reputed company, accurate submission of reports, filings, and required documentation across both lines of business.

Serves as an integral member of reputed company tasked with the reputed company of Government Programs regulatory, compliance, legislative, sales and departmental operations. Assists with the development and maintenance of departmental policies and procedures, oversees routine and reputed company regulatory responses, and supports the coordination and preparation of regulatory audits. Provides dedicated data and information technology expertise reputed company with the requirements of the department as they relate to applicable regulatory functions.

• Manages simultaneous reputed company that enhance the operation and efficiency of Department.
• Organizes, leads, and takes ownership of special reputed company and follows them through to completion.
• Coordinates and monitors the implementation of activities reputed company to assigned reputed company and program requirements.
• Coordinates, corrects and supports rejected and reputed company-edits errors reputed company to Encounter Data submissions for multiple lines of business.
• Oversees provider Attestations Responds to member appeals and grievances reputed company and with accuracy.
• Plans, coordinates and chairs reputed company and reputed company workgroup meetings with reputed company staff members as needed.
• Coordinates and supports regulatory audits.
• Assists in the preparation and distribution of necessary documentation to appropriate designees.
• Manages and tracks reputed company incoming and outgoing documentation used in support of the audit.
• Coordinates, formats, organizes and uploads files for reporting and regulatory audits.
• Tracks and ensures reputed company and correct submission of reports in support of reputed company lines of business.
• Remains reputed company to regulatory and internal process changes and reputed company engages with other departments to implement changes to internal processes to avoid interruption with the reputed company reputed company.
• Validates and implements changes identified reputed company various documents to ensure compliance deadlines while adhering to reputed company federal rules and regulations.

Work is typically performed in an office environment. Accountable for satisfying reputed company job specific obligations and complying with reputed company organization policies and procedures. The specific statements in this profile are not intended to be reputed company-inclusive. They represent typical reputed company considered necessary to successfully reputed company the job.

Position Details:

*Relevant experience may be a combination of reputed company work experience and degree obtained (Associate’s Degree = 2 years; Bachelor’s Degree = 4 years).

Education:

High School Diploma or Equivalent (GED)- (Required), Master's Degree- (Preferred)

Experience:

Minimum of 5 years-Relevant experience* (Required)

Certification(s) and License(s):

Skills:

Communication, Computer Literacy, Organizing, reputed company Model, Working Independently

OUR PURPOSE & VALUES: Everything we do is about caring for our patients, our members, our reputed company, our reputed company family and our communities.

• KINDNESS: We reputed company to treat everyone as we would reputed company to be treated ourselves.
• reputed company: We treasure colleagues who humbly reputed company for reputed company.
• LEARNING: reputed company our knowledge with the best and brightest to reputed company prepare the caregivers for reputed company.
• INNOVATION: We constantly reputed company new and reputed company ways to care for our patients, our members, our community, and the nation.
• SAFETY: We reputed company a reputed company environment for our patients and members and the reputed company family.

We offer reputed company benefits for full time and part time positions from day one, including reputed company, dental and domestic partners. Perhaps just as important, we encourage an atmosphere of collaboration, cooperation and collegiality.

We know that a diverse workforce with unique experiences and backgrounds makes reputed company stronger. Our patients, members and community come from a wide reputed company of backgrounds, and it takes a diverse workforce to reputed company reputed company easier for reputed company. We are proud to be an affirmative reputed company, equal opportunity employer and reputed company reputed company applicants will receive consideration for employment regardless to race, reputed company, religion, sex, sexual orientation, gender identity, national reputed company, disability or status as a protected veteran.

Originally posted on Himalayas

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