retention specialist in cypress

posted
job type
contract
salary
US$ 18 per hour
apply now

job details

posted
location
cypress, california
job category
Administrative & Support Services
job type
contract
salary
US$ 18 per hour
reference number
434965
apply now

job description

job summary:

Retention Specialist

Job Summary

The Retention Specialist is a critical member of Operations Quality Management Team and works closely with the Operational areas in Tampa to identify real time abrasion/disenrollment potentials. The Operational Retention team will identify areas of process breakdown and potential disenrollment to help build provider and member retention strategies based on detailed data analysis on Claims, Customer/Provider Service and Enrollment.

Responsibilities

  • Analyze reports Claims denials, front-end rejects, denials reason codes to determine appropriateness and areas of intervention.
  • Determine report specifications for ad-hoc reports needed for key abrasion/retention efforts and summarize accordingly.
  • Analyze daily call contact reports to determine accuracy, follow up, time frames and possible disenrollment threats.
  • Contact Members at risk for disenrollment based on report analysis and act as an elevated resolution team.
  • Identify additional areas of clarification needed for members and providers based on call contact reports and claims reporting.
  • Communicate findings to Operations, Marketing. Quality etc. to facilitate the creation of needed job aides, areas of training, member material updates, newsletter updates. Etc.
  • Monitor analyze and report information from Results (outsource vendor) for disenrollment survey information.
  • Communicate with the Operations Manager weekly regarding key areas of member and provider abrasion for tracking and trending.
  • Analyze grievance report data to determine trends, updated training needs, adherence to State reporting guidelines and communications.
  • Work with the Operations Manager on the Maintenance of SharePoint communication documents, banner messages, automatic email updates and compliance alerts.
  • Monitor Ohio NOA process reports as well as Right to State Hearing documentation to identify appropriateness of that decision.
  • Performs other duties as assigned.
  • Maintain project plans as needed for tight control on issue resolution.
  • Research Ad-hoc issues related to Abrasion and retention.
  • Report appropriately for proper identification of Operational Quality Standards.

Qualifications

  • Education: An Associate's Degree in a related field Required - A Bachelor's Degree in a related field Preferred
  • Work Experience: 3+ years of experience in managed care or health plan focusing on claims processing, reimbursement methodologies and charge systems required - 2+ years of experience in data analysis/financial analysis with healthcare data Preferred
  • Technology: Microsoft Project Intermediate Required---Microsoft Access Intermediate Required---Microsoft PowerPoint Intermediate Required---Microsoft Excel Intermediate Required---Other Familiarity with reporting tools (Crystal. Discovery. etc.) Intermediate Required---Other Experience with HSD Diamond managed care system Intermediate Preferred
  • Demonstrated analytical skills
  • Demonstrated project management skills
  • Demonstrated interpersonal/verbal communication skills
  • Demonstrated written communication skills
  • Ability to multi-task
  • Ability to summarize large amounts of information into intelligent key points
 
location: Cypress, California
job type: Contract
work hours: 8 to 5
education: Associate's degree
experience: 3 Years
 
responsibilities:

Responsibilities

  • Analyze reports Claims denials, front-end rejects, denials reason codes to determine appropriateness and areas of intervention.
  • Determine report specifications for ad-hoc reports needed for key abrasion/retention efforts and summarize accordingly.
  • Analyze daily call contact reports to determine accuracy, follow up, time frames and possible disenrollment threats.
  • Contact Members at risk for disenrollment based on report analysis and act as an elevated resolution team.
  • Identify additional areas of clarification needed for members and providers based on call contact reports and claims reporting.
  • Communicate findings to Operations, Marketing. Quality etc. to facilitate the creation of needed job aides, areas of training, member material updates, newsletter updates. Etc.
  • Monitor analyze and report information from Results (outsource vendor) for disenrollment survey information.
  • Communicate with the Operations Manager weekly regarding key areas of member and provider abrasion for tracking and trending.
  • Analyze grievance report data to determine trends, updated training needs, adherence to State reporting guidelines and communications.
  • Work with the Operations Manager on the Maintenance of SharePoint communication documents, banner messages, automatic email updates and compliance alerts.
  • Monitor Ohio NOA process reports as well as Right to State Hearing documentation to identify appropriateness of that decision.
  • Performs other duties as assigned.
  • Maintain project plans as needed for tight control on issue resolution.
  • Research Ad-hoc issues related to Abrasion and retention.
  • Report appropriately for proper identification of Operational Quality Standards.
 
qualifications:

Qualifications

  • Education: An Associate's Degree in a related field Required - A Bachelor's Degree in a related field Preferred
  • Work Experience: 3+ years of experience in managed care or health plan focusing on claims processing, reimbursement methodologies and charge systems required - 2+ years of experience in data analysis/financial analysis with healthcare data Preferred
  • Technology: Microsoft Project Intermediate Required---Microsoft Access Intermediate Required---Microsoft PowerPoint Intermediate Required---Microsoft Excel Intermediate Required---Other Familiarity with reporting tools (Crystal. Discovery. etc.) Intermediate Required---Other Experience with HSD Diamond managed care system Intermediate Preferred
  • Demonstrated analytical skills
  • Demonstrated project management skills
  • Demonstrated interpersonal/verbal communication skills
  • Demonstrated written communication skills
  • Ability to multi-task
  • Ability to summarize large amounts of information into intelligent key points
 
skills: Managed Care

Equal Opportunity Employer: Race, Color, Religion, Sex, Sexual Orientation, Gender Identity, National Origin, Age, Genetic Information, Disability, Protected Veteran Status, or any other legally protected group status.

Qualified applicants in San Francisco with criminal histories will be considered for employment in accordance with the San Francisco Fair Chance Ordinance.

We will consider for employment all qualified Applicants, including those with criminal histories, in a manner consistent with the requirements of applicable state and local laws, including the City of Los Angeles' Fair Chance Initiative for Hiring Ordinance.

skills

Managed Care

qualification

 

Qualifications

  • Education: An Associate's Degree in a related field Required – A Bachelor's Degree in a related field Preferred
  • Work Experience: 3+ years of experience in managed care or health plan focusing on claims processing, reimbursement methodologies and charge systems required – 2+ years of experience in data analysis/financial analysis with healthcare data Preferred
  • Technology: Microsoft Project Intermediate Required---Microsoft Access Intermediate Required---Microsoft PowerPoint Intermediate Required---Microsoft Excel Intermediate Required---Other Familiarity with reporting tools (Crystal. Discovery. etc.) Intermediate Required---Other Experience with HSD Diamond managed care system Intermediate Preferred
  • Demonstrated analytical skills
  • Demonstrated project management skills
  • Demonstrated interpersonal/verbal communication skills
  • Demonstrated written communication skills
  • Ability to multi-task
  • Ability to summarize large amounts of information into intelligent key points

responsibilities

Responsibilities

  • Analyze reports Claims denials, front-end rejects, denials reason codes to determine appropriateness and areas of intervention.
  • Determine report specifications for ad-hoc reports needed for key abrasion/retention efforts and summarize accordingly.
  • Analyze daily call contact reports to determine accuracy, follow up, time frames and possible disenrollment threats.
  • Contact Members at risk for disenrollment based on report analysis and act as an elevated resolution team.
  • Identify additional areas of clarification needed for members and providers based on call contact reports and claims reporting.
  • Communicate findings to Operations, Marketing. Quality etc. to facilitate the creation of needed job aides, areas of training, member material updates, newsletter updates. Etc.
  • Monitor analyze and report information from Results (outsource vendor) for disenrollment survey information.
  • Communicate with the Operations Manager weekly regarding key areas of member and provider abrasion for tracking and trending.
  • Analyze grievance report data to determine trends, updated training needs, adherence to State reporting guidelines and communications.
  • Work with the Operations Manager on the Maintenance of SharePoint communication documents, banner messages, automatic email updates and compliance alerts.
  • Monitor Ohio NOA process reports as well as Right to State Hearing documentation to identify appropriateness of that decision.
  • Performs other duties as assigned.
  • Maintain project plans as needed for tight control on issue resolution.
  • Research Ad-hoc issues related to Abrasion and retention.
  • Report appropriately for proper identification of Operational Quality Standards.

educational requirements

Associate's degree