Retention Specialist

  • location: Poughkeepsie, NY
  • type: Contract
  • salary: $19.89 per hour
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job description

Retention Specialist

job summary:
JOB SUMMARY

  • The Retention Specialist is a critical member of Operations Quality Management Team and works closely with the Operational areas in Tampa to identify real time abrasion/disenrollment potentials.
  • The Operational Retention team will identify areas of process breakdown and potential disenrollment to help build provider and member retention strategies based on detailed data analysis on Claims.
  • Customer/Provider Service and Enrollment.
ESSENTIAL FUNCTIONS ---- Note: The following is not intended to be an exhaustive list of all duties required of this position ---- Key Duties and Responsibilities

  • Analyze reports Claims denials. front-end rejects. denials reason codes to determine appropriateness and areas of intervention.
  • Determine report specifications for ad-hoc reports needed for key abrasion/retention efforts and summarize accordingly.
  • Analyze daily call contact reports to determine accuracy ,follow up time frames and possible disenrollment threats.
  • Contact Members at risk for disenrollment based on report analysis and act as an elevated resolution team.
  • Identify additional areas of clarification needed for members and providers based on call contact reports and claims reporting.
  • Communicate findings to Operations, Marketing, Quality etc.. to facilitate the creation of needed job aides areas of training member material updates newsletter updates. etc.
  • Monitor analyze and report information from Results (outsource vendor) for disenrollment survey information.
  • Communicate with the Operations Manager weekly regarding key areas of member and provider abrasion for tracking and trending.
  • Analyze grievance report data to determine trends. updated training needs adherence to State reporting guidelines. and communications.
  • Work with the Operations Manager on the Maintenance of Sharepoint communication documents banner messages automatic email updates and compliance alerts.
  • Monitor Ohio NOA process reports as well as Right to State Hearing documentation to identify appropriateness of that decision.
  • Performs other duties as assigned.
  • Additional Position Responsibilities- Optional
  • Maintain project plans as needed for tight control on issue resolution.
  • Research Ad-hoc issues related to Abrasion and retention.
  • Report appropriately for proper identification of Operational Quality Standards.
MINIMUM QUALIFICATIONS ---- Education ---- State the minimum required for the job ---- Education Level Education Details Required/Preferred

  • An Associate's Degree in a related field Required
  • A Bachelor's Degree in a related field Preferred
Work Experience ---- State the minimum required for the job ---- Experience Level Experience Details Required/Preferred

  • 3+ years of experience in managed care or health plan focusing on claims processing reimbursement methodologies and charge systems Required
  • 2+ years of experience in data analysis/financial analysis with healthcare data Preferred
  • Other Government programs experience (Medicare and Medicaid) Preferred
Licenses and Certifications ---- List professional licenses and certifications associated with this job ---- Licenses/Certifications Other Licenses/Certifications Required/Preferred

Skills ---- State the minimum required for the job ---- Skill Sets Other Skills Proficiency

  • Demonstrated analytical skills Advanced
  • Demonstrated project management skills Advanced
  • Demonstrated interpersonal/verbal communication skills Advanced
  • Demonstrated written communication skills Advanced
  • Ability to multi-task Intermediate
  • Other Technical writing skills Advanced
  • Other Ability to summarize large amounts of information into intelligent -key points
Technology ---- List technical skills associated with the job ---- Technology Other Technology Proficiency Required/Preferred

  • Microsoft Project Intermediate Required
  • Microsoft Access Intermediate Required
  • Microsoft PowerPoint Intermediate Required
  • Microsoft Excel Intermediate Required
  • Other Familiarity with reporting tools (Crystal. Discovery. etc.) Intermediate Required
  • Other Experience with HSD Diamond managed care system Intermediate Preferred
Languages ---- List all that apply ---- Languages Other Languages Required/Preferred

Bilingual (English/Spanish speaking), experienced Admn in Poughkeepsie. Person must be a fast learner who can work with members in person and over the phone.

 
location: Poughkeepsie, New York
job type: Contract
work hours: 8 to 5
education: Associate's degree
experience: 3 Years
 
responsibilities:
ESSENTIAL FUNCTIONS ---- Note: The following is not intended to be an exhaustive list of all duties required of this position ---- Key Duties and Responsibilities

  • Analyze reports Claims denials. front-end rejects. denials reason codes to determine appropriateness and areas of intervention.
  • Determine report specifications for ad-hoc reports needed for key abrasion/retention efforts and summarize accordingly.
  • Analyze daily call contact reports to determine accuracy ,follow up time frames and possible disenrollment threats.
  • Contact Members at risk for disenrollment based on report analysis and act as an elevated resolution team.
  • Identify additional areas of clarification needed for members and providers based on call contact reports and claims reporting.
  • Communicate findings to Operations, Marketing, Quality etc.. to facilitate the creation of needed job aides areas of training member material updates newsletter updates. etc.
  • Monitor analyze and report information from Results (outsource vendor) for disenrollment survey information.
  • Communicate with the Operations Manager weekly regarding key areas of member and provider abrasion for tracking and trending.
  • Analyze grievance report data to determine trends. updated training needs adherence to State reporting guidelines. and communications.
  • Work with the Operations Manager on the Maintenance of Sharepoint communication documents banner messages automatic email updates and compliance alerts.
  • Monitor Ohio NOA process reports as well as Right to State Hearing documentation to identify appropriateness of that decision.
  • Performs other duties as assigned.
  • Additional Position Responsibilities- Optional
  • Maintain project plans as needed for tight control on issue resolution.
  • Research Ad-hoc issues related to Abrasion and retention.
  • Report appropriately for proper identification of Operational Quality Standards.
 
qualifications:
MINIMUM QUALIFICATIONS ---- Education ---- State the minimum required for the job ---- Education Level Education Details Required/Preferred

  • An Associate's Degree in a related field Required
  • A Bachelor's Degree in a related field Preferred
Work Experience ---- State the minimum required for the job ---- Experience Level Experience Details Required/Preferred

  • 3+ years of experience in managed care or health plan focusing on claims processing reimbursement methodologies and charge systems Required
  • 2+ years of experience in data analysis/financial analysis with healthcare data Preferred
  • Other Government programs experience (Medicare and Medicaid) Preferred
Licenses and Certifications ---- List professional licenses and certifications associated with this job ---- Licenses/Certifications Other Licenses/Certifications Required/Preferred

Skills ---- State the minimum required for the job ---- Skill Sets Other Skills Proficiency

  • Demonstrated analytical skills Advanced
  • Demonstrated project management skills Advanced
  • Demonstrated interpersonal/verbal communication skills Advanced
  • Demonstrated written communication skills Advanced
  • Ability to multi-task Intermediate
  • Other Technical writing skills Advanced
  • Other Ability to summarize large amounts of information into intelligent -key points
Technology ---- List technical skills associated with the job ---- Technology Other Technology Proficiency Required/Preferred

  • Microsoft Project Intermediate Required
  • Microsoft Access Intermediate Required
  • Microsoft PowerPoint Intermediate Required
  • Microsoft Excel Intermediate Required
  • Other Familiarity with reporting tools (Crystal. Discovery. etc.) Intermediate Required
  • Other Experience with HSD Diamond managed care system Intermediate Preferred
 
skills: Other
Equal Opportunity Employer: Race, Color, Religion, Sex, Sexual Orientation, Gender Identity, National Origin, Age, Genetic Information, Disability, Protected Veteran Status, or any other legally protected group status.

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    Retention Specialist

  • location: Poughkeepsie, NY
  • job type: Contract
  • salary: $19.89 per hour
  • date posted: 10/16/2019