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HRA - Clinical Ops - Implementation Specialist, Clinical Services

Gardena, CA, USA ● Virtual Req #243
Wednesday, February 2, 2022
Episource, with over 3500 employees worldwide, is a leading provider of risk adjustment services and solutions for health plans.  Our services help Medicare Advantage, Commercial/Exchange, and Medicaid managed care plans improve and support accurate reimbursement in a post-Affordable Care Act market. Our services include retrospective chart reviews, medical record retrieval, HEDIS/ACO quality reporting, and data analytics, allowing payers and providers to dramatically reduce costs and improve quality of care.  

Job Summary:


This role is responsible for the efficient implementation and execution of client projects. Reporting to the Implementation Manager, this individual is accountable for leading client implementation meetings, fulfilling client requests, performing routine client membership and data updates, leading cross-functional issue resolution, and monitoring vendor and/or operational team performance.  The Operations Specialist may also be assigned special projects to implement or may assist with optimizing processes and systems.

Essential Duties & Responsibilities:

 

  • Serve as an internal point of contact for project-related requests by developing execution plans, securing appropriate resources, and prioritizing against other initiatives, as required
  • Spearhead implementation for multiple client projects simultaneously, including leading clients through internal implementation checklists, scrubbing and submitting client data requests, and keeping internal and external stakeholders on task to meet deadlines
  • Monitor and report on operational KPIs and SLA compliance for internal teams and vendors
  • Escalate project performance issues to stakeholders and execute corrective action plans using project management software, various applications, and internal reporting
  • Manage and complete project specific data requests, membership file loads, claims processing, eligibility file updates and other related client reporting
  • Autonomously manage complex projects in support of client programs or internal process improvement initiatives
  • May be assigned other duties
  • Must be able to handle PHI / PII data in a secure work environment
  • Must maintain compliance with all company policies and procedures

 

Additional Responsibilities


  • Must be able to work under pressure and meet deadlines, while maintaining a positive attitude
  • Ability to work independently and in teams to carry out assignments to completion within parameters of instructions given, prescribed routines and standard accepted practices.
  • Develops and maintains strong relationships with all internal and external stakeholders


Qualifications / Requirements:

 

  • 2-3 years of work experience in a professional setting
  • Intermediate Excel skills required
  • Bachelor’s degree required
  • Healthcare experience preferred
  • Salesforce experience preferred
  • Project management experience preferred
  • Detail oriented and extremely organized
  • Ability to multi-task and work under pressure in a fast-paced environment
  • Ability to work independently with limited supervision
  • Ability to work within different platforms and applications
  • Ability to perform repetitive work according to set procedures 
  • Proficiency with MS Office and G-suite (Gmail, Google Sheets, etc.) required

 

Physical Requirements:


  • Ability to safely and successfully perform the essential job functions consistent with the ADA, FMLA and other federal, state and local standards, including meeting productivity standards.
  • Must be able to talk, listen, speak and view (close vision, distance vision, color vision, peripheral vision, depth perception, and the ability to adjust focus) as required to:  Read printed material on paper and similar medium, on a PC or similar electronic devices.


Working Conditions:


  • Working conditions are normal for an office environment. 
  • Requires prolonged sitting, some standing, some bending, stooping, and stretching, requires eye-hand coordination and manual dexterity sufficient to operate a computer keyboard, photocopier, telephone, and other office equipment.
  • Work may require occasional weekend and/or evening work.
  • Some travel may be required (up to 10%)


Training /Certification Requirements:


  • Company compliance program modules

·        Company safety regulations

Episource, LLC provides equal employment opportunities (EEO) to all employees and applicants for employment without regard to race, color, religion, gender, sexual orientation, gender identity or expression, national origin, age, disability, genetic information, marital status, amnesty, or status as a covered veteran in accordance with applicable federal, state and local laws. Episource, LLC complies with applicable state and local laws governing non-discrimination in employment in every location in which the company has facilities. This policy applies to all terms and conditions of employment, including, but not limited to, hiring, placement, promotion, termination, layoff, recall, transfer, leave of absence, compensation, and training.


Episource, LLC expressly prohibits any form of unlawful employee harassment based on race, color, religion, gender, sexual orientation, gender identity or expression, national origin, age, genetic information, disability, or veteran status. Improper interference with the ability of Episource, LLC employees to perform their expected job duties is absolutely not tolerated.

Other details

  • Pay Type Salary
  • Job Start Date Wednesday, February 2, 2022
Location on Google Maps
  • Gardena, CA, USA
  • Virtual