21 days old

Membership Quality Lead - San Antonio, TX - 938419

San Antonio, TX 78205
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  • Job Code
    938419

Combine two of the fastest-growing fields on the planet with a culture of performance, collaboration and opportunity and this is what you get. Leading edge technology in an industry that's improving the lives of millions. Here, innovation isn't about another gadget, it's about making healthcare data available wherever and whenever people need it, safely and reliably. There's no room for error. Join us and start doing your life's best work.(sm)

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The Membership Quality Lead will be a key contributor in developing and maintaining a Quality Assurance program for an operational area responsible for maintaining membership and loading eligibility via an EDI load process. This position will be responsible for ensuring all business process documentation is current and organized electronically. In addition, the Membership Quality Lead will collaborate with business leads to identify process efficiencies where quality can be improved.

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Primary Responsibilities:
" Create the format and structure for all business process documentation
" Assist in the revision and/or creation of documentation, ensuring all business processes are documented in the same format/structure, presented in an easily digestible format and are readily available to all users
" Pilot/Road Test documentation with end users to ensure information is fit for purpose.
" Research, recommend and assist with implementation of quality auditing tools within allowed budget
" Lead in the development of systems that automate the identification of membership or eligibility errors and tracks errors and resolutions
" Lead in the development of tools to facilitate the sharing of information and feedback with customers
" Oversee day to day operations of quality auditors and assist with prioritizing workload.
" Lead projects associated with compliance audits and focus audits
" Analyze information flows, develop flow charts and decision trees and report results.
" Analyze data and reports results during audit initiatives
" Understand, interpret and apply business policies and procedures that impact membership and eligibility accuracy
" Maintain current knowledge of CMS/Medicare Advantage regulations in support of audit initiatives
" Perform all other related duties as assigned

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Youll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.

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Required Qualifications:
" Undergraduate degree in Business, Healthcare or related field or equivalent in work experience of at least 4 years
" 4+ years of managed care experience or healthcare industry experience
" 2+ years of experience as lead or quality assurance analyst
" 1 year of experience as a business or technical writer
" Tech-savvy with the ability to maintain and organize electronic files
" Team player with the ability to collaborate with all departments
" Advanced level user of MS Office applications, i.e. Word, Excel and SharePoint
" Ability to make decisions based on sound knowledge
" Performs a variety of tasks that may require a limited degree of creativity and latitude
" This is an office-based position in San Antonio, TX
" If you need to enter a work site for any reason, you will be required to screen for symptoms using the ProtectWell mobile app, Interactive Voice Response (i.e., entering your symptoms via phone system) or a similar UnitedHealth Group-approved symptom screener. Employees must comply with any state and local masking orders. In addition, when in a UnitedHealth Group building, employees are expected to wear a mask in areas where physical distancing cannot be attained.
" You will be asked to perform this role in an office setting or other company location. Employees are required to screen for symptoms using the ProtectWell mobile app, Interactive Voice Response (i.e., entering your symptoms via phone system) or a similar UnitedHealth Group-approved symptom screener prior to entering the work site each day, in order to keep our work sites safe. Employees must comply with any state and local masking orders. In addition, when in a UnitedHealth Group building, employees are expected to wear a mask in areas where physical distancing cannot be attained.

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Preferred Qualifications:
" Prior experience developing a Quality Assurance program
" CMS/Medicare Advantage regulation experience

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Careers with WellMed. Our focus is simple. We're innovators in preventative health care, striving to change the face of health care for seniors. We're impacting 380,000+ lives, primarily Medicare eligible seniors in Texas and Florida, through primary and multi-specialty clinics, and contracted medical management services. We've joined Optum, part of the UnitedHealth Group family of companies, and our mission is to help the sick become well and to help patients understand and control their health in a lifelong effort at wellness. Our providers and staff are selected for their dedication and focus on preventative, proactive care. For you, that means one incredible team and a singular opportunity to do your life's best work.(sm)

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Diversity creates a healthier atmosphere: UnitedHealth Group is an Equal Employment Opportunity/Affirmative Action employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law.
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"UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.

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Job Keywords: San Antonio, Texas, TX, Quality Assurance, Medicare, CMS, Membership, Quality, Healthcare, Managed Care

Posted: 2021-07-03 Expires: 2021-08-02

UnitedHealth Group is the most diversified health care company in the United States and a leader worldwide in helping people live healthier lives and helping to make the health system work better for everyone.

Sponsored by:
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Membership Quality Lead - San Antonio, TX - 938419

UnitedHealth Group
San Antonio, TX 78205

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