Operations Specialist Claims

tango; Phoenix (AZ); Remote; USD 65,000 - 85,000; Full time

Job summary

Join a leading healthcare organization as an Operations Specialist Claims, offering administrative support for the day-to-day operations of the Claims team. This position involves optimizing team performance, training staff, and maintaining documentation while navigating a dynamic work environment.

Qualifications

• 3-5 years Medicare/Medicaid claims experience required.
• Significant experience in Microsoft applications required.
• Home Health background preferred.

Responsibilities

• Provide administrative support to the Claims team.
• Document requirements and procedures.
• Train Claims Staff on policies and procedures.

Skills

Data analysis

Communication skills

Organizational skills

Ability to multitask

Education

Some College

Tools

Microsoft Word

Microsoft Excel

Power BI

PowerPoint

Job description

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Position Description

The Operations Specialist is responsible for providing administrative support to the day-to-day operations of the Claims team. In partnership with the Claims Management leadership, the Operations Specialist identifies, evaluates, and optimizes the daily activities and performance of the Claims team.

Brief Description

Position: Operations Specialist Claims

Department: Claims

Reports to: Claims Supervisor

Position Description

The Operations Specialist is responsible for providing administrative support to the day-to-day operations of the Claims team. In partnership with the Claims Management leadership, the Operations Specialist identifies, evaluates, and optimizes the daily activities and performance of the Claims team.

Office Location:

• Office located at 7600 North 16th Street, Suite 140 Phoenix, AZ 85020 (Remote)
  
  

Responsibilities And Duties

Responsibilities include, but are not limited to the following:

• Working closely with leadership:
• Document requirements for implementations or enhancements
• Document desktop procedures for new or changed processes
• Monitor implementations, post go-live, for accuracy and needed corrections. Support required corrections.
• Maintain job aids, EOP insert revisions/version control
• Train Claims Staff on Standard Policies and Procedures
• Maintain Desktop Procedures for Payor Audits
• Maintain security measures for claims applications for onboarding/offboarding
• Symkey Daily Robot Checks
• Maintain/Distributes Claims Dashboards Trends/Patterns by the 5th of the month
• Develop Team Building Activities Quarterly with support of Claims Leadership
• Develop/Maintain GURU Claims Dashboard and Cards and develop reporting on usage/ROI’s etc.
• Develop Testing Schedules/Accountabilities with results/lessons learned
• Perform time studies within claims and document process steps, as needed.
• Act as the liaison between Reporting/Data Analytics and Claims Management, collaborating on reporting enhancements and needs.
• Distribute reports to internal and external stakeholders.
• Other duties to support Claims goals, initiatives, quality, compliance, or efficiency.
  
  

Qualifications

• Some College required
• 3-5 years Medicare/Medicaid claims experience required
• Has significant experience utilizing Microsoft Word, Excel, PowerPoint and other web applications
• Has advanced experience in Power BI Reports
• Capable of working independently in following an issue through to its conclusion.
• Home Health background preferred
• Excellent data analysis skills- review data to identify trends and anomalies and identify opportunities
• Excellent oral and written communication skills.
• Excellent presentation skills
  
  

Proven Personal Attributes

• Must be able to work at a fast pace managing large amounts of responsibilities.
• Detail oriented and displays good organizational skills.
• Highly self-motivated and able to work with minimal supervision.
• Self-directed, flexible, and cooperative.
• Ability to multitask in a fast-paced work environment.
• Ability to remain calm under pressure and manage stressful situations.
• Ability to maintain a high level of confidentiality and remain HIPAA compliant.
• Ability to establish highly productive and detailed organizational skills/habits.
• Ability to actively listen and solve problems with cooperation, assertiveness, and flexibility for positive outcomes.
• Possess strong, professional written and oral communication skills for in-person, telephonic, and electronic use.
  
  

Job Type

• Full-time
• Remote - United States
  
  

tango provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws. tango will make reasonable accommodations for qualified individuals with known disabilities unless doing so would result in an undue hardship.

Seniority level

• Seniority level

  Mid-Senior level

Employment type

• Employment type

  Full-time

Job function

• Job function

  Management and Manufacturing

• Industries

  Hospitals and Health Care

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