Member Operations Supervisor

Metropolitan Jewish Health System; New York (NY); On-site; USD 60,000 - 100,000; Full time

Job summary

An established industry player in healthcare is seeking a dedicated Member Operations Manager to oversee daily activities and enhance operational workflows. This role involves analyzing procedures, managing audits, and ensuring compliance with regulatory standards. The ideal candidate will possess strong analytical abilities, multitasking skills, and proficiency in essential software tools. Join a forward-thinking organization committed to providing high-quality care and making a meaningful impact on the lives of its members. If you are passionate about healthcare and looking for a challenging yet rewarding opportunity, this position is for you.

Qualifications

• Bachelor's degree required; Master's degree preferred.
• Two years experience in a supervisory role preferred.
• Knowledge of managed care organizations and regulations.

Responsibilities

• Manage day-to-day activities of the Member Operations staff.
• Analyze existing procedures and develop workflows based on analysis.
• Prepare for and participate in external regulatory audits.

Skills

Multitasking

Analytical Skills

Communication

Education

Bachelor's Degree

Master's Degree

Tools

MS Office (Access, Excel, PowerPoint, Word)

AMISYS

Market Prominence

Crystal Reports

Job description

The challenges of affordable healthcare continue to create new opportunities. Elderplan and HomeFirst, our Medicare and Medicaid managed care health plans, are outstanding examples of how we are expanding services in response to our patients' and members' needs. These high-quality healthcare plans are designed to help keep people independent and living life on their own terms.

Responsible for managing day-to-day activities of the Member Operations staff. Analyzes existing procedures and develops workflows and processes based on analysis and regulatory changes, and communicates these changes to staff. Manages the internal audit processes and recommends appropriate action. Generates, maintains and distributes member eligibility files to vendors by the secure means and according to the distribution schedule specified by the vendor. Prepares for, and participates in, external regulatory audits (e.g. DOH, DOI, and CMS). Assist the Director with the production of the monthly board reports.

• Bachelor's degree required, Master's degree preferred
• Two years experience in a supervisory role preferred
• Proficiency in MS office (Access, Excel, PowerPoint, Word) required; experience with AMISYS, Market Prominence, Crystal Reports preferred
• Knowledge of managed care organizations, CMS and Federal regulations
• Ability to multitask, think and act independently, delegate appropriately
• Detailed oriented and analytical