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QA Analyst I

Company: SCAN Health Plan
Location: Long Beach
Posted on: September 18, 2022

Job Description:

SCAN Group is a not-for-profit organization dedicated to tackling the most pressing issues facing older adults in the United States. SCAN Group is the sole corporate member of SCAN Health Plan, one of the nation's leading not-for-profit Medicare Advantage plans, serving more than 270,000 members in California, Arizona, and Nevada. SCAN has been a mission-driven organization dedicated to keeping seniors healthy and independent for more than 40 years and is known throughout the healthcare industry and nationally as a leading expert in senior healthcare. SCAN employees are a group of talented, passionate professionals who are committed to supporting older adults on their aging journey, while also innovating healthcare for seniors everywhere. Employees are provided in-depth training and access to state-of-the-art tools necessary to do their jobs, as well as development and growth opportunities. SCAN takes great pride in recognizing our team members as experts in their fields and rewarding them for their efforts. If you are interested in becoming part of an organization that is innovating senior healthcare visit -www.thescangroup.org , -www.scanhealthplan.com , or follow us on LinkedIn, Facebook, and Twitter.The jobEnsure that the activities of the Enrollment, Reconciliation, and Premium Billing Department adhere to guidelines established by the Centers of Medicare and Medicaid Services (CMS), the Department of Health Care Services (DHCS), and other regulating agencies.Support business units external, and internal, to the Enrollment, Reconciliation and Premium Billing Department with production, reconciliation, and auditing efforts by completing regular and ad hoc projects involving data validation and reconciliation.Support the Enrollment, Reconciliation and Premium Billing Department's maintenance and development efforts for critical core systems used to store membership eligibility data, membership eligibility history, retired systems data, and file/record management.You Will

  • Execute daily systematic validations against the core processing systems to ensure departmental completion of critical processes performed to maintain eligibility details for the organization's membership.
  • Review applicable organizational communications regarding changes to regulatory requirements and/or changes in data report file layouts and specifications from any/all regulatory agencies. Provide impact analysis for all related processes currently in place within the department and draft action plans to address and incorporate changes into the routine operations of the department.
  • Participate in, and/or lead process design sessions to develop new processes, enhance, or remediate existing processes in response to changes in regulatory requirements or data file specifications.
  • Support, or lead, regulatory audits of eligibility data and/or processes governed by the Enrollment, Reconciliation and Premium Billing Department by reviewing and interpreting audit requests and requirements, presenting final analysis and proposed strategies to management on how to fulfill audit requests, researching and documenting findings for audit selections during the external agency audit procedures, and pulling and providing individual documents for selected cases during the external agency audit procedures.
  • Conduct routine process analysis for department's operating procedures and validate compliance with regulatory requirements or develop details assessment outlining gaps/risks identified with proposed process redesigns to mitigate identified gaps and risks.
  • Develop and implement operating procedures to support the department's production and reconciliation processes by developing a series of queries to interpret and develop data results
  • and developing standard operating procedure documents to outline the operating actions to be performed.
  • Develop and perform routine audits internal to the Enrollment, Reconciliation and Premium Billing Department by identifying measurable regulatory requirements applicable to departmental processes, developing methods designed to accurately measure the department's compliance with the requirement, identifying the applicable audit universe within the review period(s), creating sample selections, reviewing individual cases and results to identify outliers, and reviewing results with management with proposed solutions to remedy findings.
  • Develop and maintain departmental Policy and Procedure documents used by the organization to evidence the plan's standard operating procedures that support critical business functions and demonstrate compliance with regulatory requirements.
  • Work directly with external system and fulfillment vendors to maintain system functionality and accuracy, configure annual enhancements or changes, and resolve identified deficiencies.
  • Develop and execute strategic testing plans for all system implementations or enhancements by drafting and executing test plans with internal business units and by leading and coordinating, testing efforts with externally assigned teams.
  • Participate in creating process workflows and functional design documents to outline business requirements for projects related to enhancing current systems or processes and to implement new systems or processes.
  • Maintain professional and technical knowledge by attending educational workshops; reviewing professional publications; establishing personal networks; participating in professional societies.
  • Contribute to team effort by accomplishing related results as needed.
  • Actively support the achievement of SCAN's Vision and Goals.
  • Bachelor Degree or equivalent education/work experience, required.
  • 2-3 years of Eligibility & Reconciliation experience, preferably within a health plan or healthcare company.
  • Experience working with IKA platform
  • 2+ years' experience with health services industry and managed care business.
  • Proficient with MS Office (Access or SQL, Word, Excel, PowerPoint) and e-mail.
  • Demonstrates critical thinking and problem-solving skills.
  • Ability to work independently and in a team environment.
  • Strong team player
  • Strong analytical skills
  • Ability to work under tight deadlines & manage multiple responsibilities independently.
  • Strong interpersonal skills, including excellent written and communication skills.What's in it for you?
    • A competitive compensation and benefits program -
    • An annual employee bonus program
    • Robust Wellness Program
    • Generous paid-time-off (PTO)
    • Eleven paid holidays per year, plus 1 additional floating holiday
    • Excellent 401(k) Retirement Saving Plan with employer match
    • Robust employee recognition program
    • A work-life balanceAn opportunity to become part of a team that makes a difference to our members and our community every day!To ensure a healthy and safe work environment, if you are selected for this position, your job offer with SCAN Health will be contingent upon being fully vaccinated and providing proof of your COVID-19 vaccine within 3 days after your start date. Generally, you are considered fully vaccinated 14 days after receiving the last dose, as recommended by the manufacturer, of a vaccine that has been authorized by the FDA for use in the United States, including vaccinations that have been approved pursuant to an Emergency Use Authorization. If fully vaccinated outside of the United States, the vaccination must be listed for emergency use by the World Health Organization (WHO). If you cannot receive the vaccine because of a disability/medical reason or sincerely-held religious belief, you may request an accommodation to this requirement by contacting -COVID-19 Vaccination Policy . Learn more about the COVID-19 vaccination here - -https://www.cdc.gov/coronavirus/2019-ncov/vaccines/index.html We're always looking for talented people to join our team! Qualified applicants are encouraged to apply now!At SCAN we believe that it is our business to improve the state of our world. Each of us has a responsibility to drive Equality in our communities and workplaces. We are committed to creating a workforce that reflects our community through inclusive programs and initiatives such as equal pay, employee resource groups, inclusive benefits, and more. -SCAN is proud to be an Equal Employment Opportunity and Affirmative Action workplace. Individuals seeking employment will receive consideration for employment without regard to race, color, national origin, religion, age, sex (including pregnancy, childbirth or related medical conditions), sexual orientation, gender perception or identity, age, marital status, disability, protected veteran status or any other status protected by law. A background check is required. #LI-JR1Equal Opportunity Employer/Protected Veterans/Individuals with DisabilitiesThe contractor will not discharge or in any other manner discriminate against employees or applicants because they have inquired about, discussed, or disclosed their own pay or the pay of another employee or applicant. However, employees who have access to the compensation information of other employees or applicants as a part of their essential job functions cannot disclose the pay of other employees or applicants to individuals who do not otherwise have access to compensation information, unless the disclosure is (a) in response to a formal complaint or charge, (b) in furtherance of an investigation, proceeding, hearing, or action, including an investigation conducted by the employer, or (c) consistent with the contractor's legal duty to furnish information. 41 CFR 60-1.35(c)

Keywords: SCAN Health Plan, Long Beach , QA Analyst I, Professions , Long Beach, California

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