Sr Specialist, Health Services

Administrative United States


Description

American Specialty Health Incorporated is seeking a Sr Specialist, Health Services to join our Health Services department. This position will coordinate policy development and maintenance, to support accreditation compliance, and to coordinate activities that meet corporate goals in support of various departments.

Remote Worker Considerations:

Candidates who are selected for this position will be trained remotely and must be able to work from home in a designated work area with company-provided technology equipment.

Responsibilities

  • Coordinates projects and activities in support of corporate policy management.
  • Complete annual review of assigned policies within established timeframes.
  • Coordinates and manages the completion of all assigned and policy-related action items from workgroups, key process teams, and committees.
  • Incorporates revisions to policy content and updates headers/footers.
  • Performs writing and editorial tasks competently and within established time frames.
  • Researches policy content with clinical/administrative staff, as assigned.
  • Presents policy materials at committee meetings to get clarification and/or to receive input and to reach consensus.
  • Assists with filing of master policies and policy-related documentation.
  • Assists with policy changes and updates as identified by the Corporate Compliance Committee or as otherwise identified by management or other corporate directives.
  • Communicates effectively cross-departmentally and gathers documentation from other departments for policy-related issues as needed.
  • Analyzes documents with special attention to detail and accuracy, bringing questions to management to ensure accuracy and compliance with finished documents.
  • Develops and documents action plans and workflows for assigned projects.
  • Supports companywide CQI process.
  • Assists with policy development and/or revisions to support client implementations, client audits, and corrective action plans.
  • Participates in committees, workgroups, and project teams as assigned.
  • Maintains confidentiality of all member, provider, client and proprietary information.
  • Assists with projects and activities in support of corporate goals, regulatory requirements, and accreditation guidelines.
  • Assists with special projects to support corporate goals.
  • Assists with regulatory audit and filings from policy support perspective.
  • Assists with creating standards crosswalks for URAC and NCQA.
  • Assists with collecting materials and completing accreditation applications.
  • Assist with utilization management oversight audits.

Qualifications

  • Bachelor’s degree or equivalent experience preferred. If equivalent experience, high school diploma required.
  • Minimum 2 years of experience in health care administration. Knowledge of managed care operations and quality assurance techniques preferred.
  • Strong analytical, problem solving, verbal and written communication skills.
  • Ability to complete objectives, strategies, and projects related to policy research and management, accreditation management, quality improvement, and other special projects, as assigned.
  • Demonstrated strong research skills.
  • Ability to read, interpret and analyze documents.
  • Computer skills including word processing, Excel spreadsheets, Access and email.

Core Competencies

  • Demonstrated ability to interact in a positive, respectful manner and establish and maintain cooperative working relationships.
  • Ability to display excellent customer service to meet the needs and expectations of both internal and external customers.
  • Excellent listening and interpersonal communication skills to identify critical core competencies based on success factors and organizational environment.
  • Ability to effectively organize, prioritize, multi-task and manage time.
  • Demonstrated accuracy and productivity in a changing environment with constant interruptions.
  • Demonstrated ability to analyze information, problems, issues, situations and procedures to develop effective solutions.
  • Ability to exercise strict confidentiality in all matters.

Mobility

Primarily sedentary, able to sit for long periods of time. 

Physical Requirements

Ability to speak, see and hear other personnel and/or objects.  Ability to communicate both in verbal and written form. Ability to travel within the facility. Capable of using a telephone and computer keyboard.  Ability to lift up to 10 lbs.

Environmental Conditions

Usual office setting.

This job posting is not applicable in CO.

American Specialty Health is an Equal Opportunity/Affirmative Action Employer.

All qualified applicants will receive consideration for employment without regard to race, color, religion, sex including sexual orientation and gender identity, national origin, disability, protected Veteran Status, or any other characteristic protected by applicable federal, state, or local law. 

Please view Equal Employment Opportunity Posters provided by OFCCP here.

If you are a qualified individual with a disability or a disabled veteran, you have the right to request an accommodation if you are unable or limited in your ability to use or access our career center as a result of your disability. To request an accommodation, contact our Human Resources Department at (800) 848-3555 x6702.

ASH 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 Company’s legal duty to furnish information.