Associate Operations Support Analyst

by Irma Moore | Jun 12, 2024 | Uncategorized

What you’ll do

In a few words…

Abarca is igniting a revolution in healthcare.  We built our company on the belief that with smarter technology we are redefining pharmacy benefits, but this is just the beginning…

Our Operational Performance team is #All-In on centralizing data to dive through and study as they work on improving operations at Abarca. The Operational Solutions team works hand in hand with other departments to listen to their needs, analyze potential opportunities, mitigate issues, co-create preventable measures, and monitor all improvements from start to close. That’s why performance is part of their name as they help drive both scalability and efficiency across the board!

As anAssociate Operations Support Analyst, you’ll be identifying, analyzing, documenting, and reporting, as applicable, issues (programming, compliance, among others) identified by the Company, Patients, or Clients that may impact client or members. You’ll also support the timely performance and completion of all issue management activities of the organization; specifically, conducting the investigation and documentation of the description, root cause, corrective actions, preventive measures, and reporting of claims processing issues. Expect to contribute and collaborate extensively with other key functional areas to ensure the quality and integrity of the claims processing system. You’ll make recommendations for corrective action and process improvements based on documentary and report reviews and ensure proper monitoring of post-corrective actions to avoid reoccurrence.

The fundamentals for the job…

• Contribute to the definition of strategic initiatives to improve issue management, processes, tools, and reporting capabilities.
• Contribute to the development and implementation of issue management activities such as defining policies & procedures, workflows, and training.
• Participate in the preparation for CMS, client or internal audits as well as follow through on any corrective actions requiring Issue Management Support
• Contribute to the implementation and continuous development of any systems and/or tools used to support Issue Management and Problem Management activities.
• Collaborate in the development of new ideas and requirements to resolve system issues and improve current systems.
• Participate in projects and new clients’ implementations to gather understanding on new system functionalities and requirements to have a better understanding of issues and collaborate with the issue resolution.
• Understand and document system logic and/or processes.
• Collaborate and support users during issue solving activities, new business requirements gathering, and day-to-day system operation.
• Collaborate interdepartmentally with key areas within the organization.
• Support the company-wide issue management process.
• Document identified issues in accordance with Company’s policies and procedures and agreed upon SLAs.
• Ensure all incidents are addressed, and resolutions, workarounds, and/or mitigations are in place within the expected SLAs.
• Monitor Issue Management activities and be the point of contact for clients and operational areas.
• Follow-up on escalation processes to ensure Operational areas are meeting expected SLAs.
• Ensure that Issue Management process is followed by the Operational areas and the company as a whole!
• Maintain Incident Management log, reports, metrics, and ensuring these reports are sent within agreed SLAs.
• Work with Analytics and SMEs to determine impact analysis of issues identified.
• Analyze data provided in impact analysis.
• Work with Analytics and Rx Customer Service to coordinate and conduct outreach to pharmacies as part of mitigation plans.
• Communicate issues to clients in accordance with policies, procedures, and SLAs.
• Follow through with corrective actions, including but not limited to evidence of testing.
• Interface with the Client on issues identified as part of the Issue Management Strategy
• Support Quality Improvement Projects or Company projects as needed.
• Collaborate on the company-wide issue management process and committee.
• Participate and complete other tasks as assigned and other projects or duties as needed.
• What you’re made of
• The bold requirements…   
• Associate’s Degree or Bachelor’s Degree in Science, Management, Business or a related area. (In lieu of a degree, equivalent relevant work experience may be considered.)
• 1+ years of experience within a related role in a healthcare or non-retail pharmacy setting.
• Experience with project planning, management, and reporting
• Experience with pharmacy benefit management operations or Medicare Part D.
• Experience with quality, audit, controls, and business process improvements.
• Experience with data management and analysis.
• Excellent oral and written communication skills.
• We are proud to offer a flexible hybrid work model which will require certain on-site workdays (Puerto Rico Location Only)
• Nice to have…
• Certifications in areas such as Project Management, Agile or related.
• Physical requirements…
• Must be able to access and navigate each department at the organization’s facilities.
• Sedentary work that primarily involves sitting/standing.

Performance Analyst

by Irma Moore | Jun 12, 2024 | Uncategorized

Abarca is igniting a revolution in healthcare.  We built our company on the belief that with smarter technology we are redefining pharmacy benefits, but this is just the beginning…

Our Operational Performance team is #All-In on centralizing data to dive through and study as they work on improving operations at Abarca. The Performance Monitoring team has the metrics tracking down from OKRs to KPIs and proactively manages shortfalls to ensure we continuously set and reach the highest standards. That’s why performance is part of their name as they help drive both scalability and efficiency across the board!

The Performance Analyst monitors performance trends, detects anomalies, develops recommendations for the business area, and recommends opportunities for improvement to the Business Enabling Teams. Also, you make sure to take a proactive approach to tackle performance issues promptly and effectively, continuously evaluating internal key performance indicators and any barriers that might get in the way of achieving sustainable delivery of operational and technical services (in other words, provide optimal performance).

The fundamentals for the job…

• Measure and share key performance indicators [KPI] data with the organization as well as provide visibility for identifying KPI shortfalls to proactively address and continuously re-set KPIs as we set a higher standard.
• Provide management with weekly, monthly, quarterly, annual, and ad hoc consolidated reporting on key metrics.
• Update web-based performance reports (Dashboards).
• Compile and review reporting packages for each assigned area, identify areas that need further investigation prior to distribution, and communicate findings to appropriate organization personnel.
• Oversee the development of ad hoc analysis tools for department leaders and managers to evaluate performance, compare actual results to forecasts, and provide trend analysis.
• Identify and research trends that require further review and analysis.
• Lead functional review of performance metrics for business areas & program management and share insights to enable comparison and leveraging of key themes and trends, identifying potential risks for escalation.
• Ensure end-users have a solid understanding of the information available to them for review.
• Assist with problem-solving methodology and counter measure selection.
• Develop tools and programs to capture data specific to performance.
• Routinely review available systems data and prepare reports pertinent to performance measures, including recommendations.
• Participate as a functional member of a team that recommends performance improvements to management by analyzing data, policies, and researching other outside resources to contribute to company-wide improvements that drive scalability and efficiency.
• Provide outstanding customer service to internal clients and stakeholders, integrating cross-functional teams.
• Collaborate internally and interdepartmentally with key areas within the organization.
• Support and contribute to the Quality and Performance Committee meetings.

What we expect of you

The bold requirements…

• Bachelor’s or Master’s degree in Engineering, Business Administration, or related field. (In lieu of a degree, equivalent relevant work experience may be considered.)
• 3+ years of work-related experience.
• 2+ years of relevant work experience in consulting, engineering, or data analytics.
• Experience working with Microsoft Office products and extensive experience using Excel and Power Point.
• Experience related to PBM Operations and its regulations.
• Excellent oral and written communication skills.
• We are proud to offer a flexible hybrid work model which will require certain on-site workdays (Puerto Rico Location Only)

Nice to haves… 

• Experience with Power BI, Tableau, Qlikview and other data analytics tools is preferred.

Physical requirements…

• Must be able to access and navigate each department at the organization’s facilities.
• Sedentary work that primarily involves sitting/standing.

At Abarca we value and celebrate diversity. Diversity, equity, inclusion, and belonging are guiding principles of Abarca and ensure Abarca’s workforce reflects the communities it serves.  We are proud to provide equal employment opportunities to all employees and applicants for employment and prohibit discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, medical condition, genetic information, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state, or local laws.

Abarca Health LLC is an equal employment opportunity employer and participates in E-Verify.  “Applicant must be a United States’ citizen. Abarca Health LLC does not sponsor employment visas at this time”

The above description is not intended to limit the scope of the job or to exclude other duties not mentioned. It is not a final set of specifications for the position. It’s simply meant to give readers an idea of what the role entails.

#LI-REMOTE #LI-JM1

CODING SPECIALIST II – Remote – PD in Albany, New York

by Irma Moore | Jun 11, 2024 | Uncategorized

Employment Type:

Full time

Shift:

Day Shift

Description:

CODING SPECIALIST II – Remote – PD

Coding experience required

If you are looking for a remote Coding Specialist position, this could be your opportunity. Here at St. Peter’s Health Partner’s, we care for more people in more places.

Position Highlights:

Recognized leader: Magnet Hospital in the Capital Region

Quality of Life: Where career opportunities and quality of life converge

Advancement: Strong orientation program, generous tuition allowance and career development

What you will do:

The Coding Specialist II analyzes physician/provider documentation contained in health records (electronic, paper or hybrid) to determine the principal diagnosis, secondary diagnoses, principal procedure and secondary procedures.

Utilizes encoder software applications, which includes all applicable online tools and references in the assignment of Internal Classification of Diseases, Clinical Modification diagnosis and procedure codes, and Current Procedural Terminology / Healthcare Common Procedure Coding System (HCPCS) procedure codes and all required modifiers

What you will need:

Two years of current E&M Coding Experience

Experienced Oncology Coder

Completion of an AHIMA-approved coding program or an AAPC-approved coding program, or

Associate’s degree in Health Information Management or a related field or an equivalent combination of years of education and experience is required.

Certified Coding Specialist (CCS), Certified Procedural Coder (CPC), Registered Health Information

Technologist (RHIT), or Registered Health Information Administrator (RHIA) is required.

Current experience utilizing encoding/grouping software is preferred. Ability to utilize both manual and automated versions of the ICD and CPT coding classification systems is preferred.

Ability to use a standard desktop and windows based computer system, including a basic understanding of e-mail, internet, and computer navigation. Ability to use other software as required to perform the essential functions on the job. Familiarity with distance learning or using web-based training tools desirable.

Well-developed written and oral communication skills that may be used either on-site or in virtual working environments. Ability to communicate effectively with individuals and groups representing diverse perspectives.

Ability to work with minimal supervision and exercise independent judgment.

Ability to research, analyze and assimilate information from various on-site or virtual sources based on technical and experience-based knowledge. Must exhibit critical thinking skills and possess the ability to prioritize workload.

Excellent organizational skills. Ability to perform multiple duties and functions related to daily operations and maintain excellent customer service skills. Ability to perform frequent detailed tasks and provide immediate service with frequent interruptions. Ability to change and be flexible with work priorities. Strong problem-solving skills.

Must be comfortable functioning in a virtual, collaborative, shared leadership environment.

Must possess a personal presence that is characterized by a sense of honesty, integrity, and caring with the ability to inspire and motivate others to promote the philosophy, mission, vision, goals, and values of CHE Trinity Health.

Pay Range:$21.20 – $29.15

Pay is based on experience, skills, and education. Exempt positions under the Fair Labor Standards Act (FLSA) will be paid within the base salary equivalent of the stated hourly rates. The pay range may also vary within the stated range based on location.

Our Commitment to Diversity and Inclusion

Trinity Health is one of the largest not-for-profit, Catholic healthcare systems in the nation. Built on the foundation of our Mission and Core Values, we integrate diversity, equity, and inclusion in all that we do. Our colleagues have different lived experiences, customs, abilities, and talents. Together, we become our best selves. A diverse and inclusive workforce provides the most accessible and equitable care for those we serve. Trinity Health is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, status as a protected veteran, or any other status protected by law.

Fire Door Inspector

by Irma Moore | Jun 11, 2024 | Uncategorized

Fire Door Inspector –  Work from Home

Intertek is searching for a Fire Door Inspector to join our Building & Construction team.  The Inspector will support the Field Labeling business by performing inspections at existing job sites to ensure compliance with installation standards per NFPA 80, per individual component specifications based on testing and evaluations conducted by Intertek.

This position offers candidates a flexible work schedule & the ability to work from home anywhere in the Phoenix, AZ and neighboring S. CA area.

What you’ll do:

• Perform inspections on door assemblies and wall conditions to ensure compliance with installation standards
• Record the details of assemblies and wall conditions
• Provide Labels for door and frame components that meet requirements
• Document corrective actions to assembliesFproven, high-quality business model and a global network of customer-focused operations and highly engaged subject matter experts. At Intertek, we exercise our spirit of innovation, the passion of our people and our unmatched customer commitment to realize our purpose of making the world an ever better, safer, and more sustainable place for all. Learn more about Our History and What We Do.

What we have to offer:
When Working with Intertek, you can expect salary and benefit package competitively placed within the local market, including medical, dental, vision, life, disability, 401(k) with company match, tuition reimbursement and more.

Intertek is a drug-free workplace. As a condition of employment, all hires are required to pass a pre-employment drug test.

Intertek believes that Our People are our strongest tool for success. We are an Equal Opportunity Employer and do not discriminate against applicants due to veteran status or on the basis of disability. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, sexual orientation, or gender identity.

For individuals with disabilities who would like to request an accommodation, or who need assistance applying, please email [email protected] or call 1-877-694-8543 (option #5) to speak with a member of the HR Department.

Jira Lead (Remote) in Olympia, Washington

by Irma Moore | Jun 11, 2024 | Uncategorized

Overview

GovCIO is currently hiring for a Jira Lead (Remote) to support the Summit Data Platform program at the VA.This position is a fully remote position with the United States.

Responsibilities

The Jira Lead will play a crucial role in optimizing the use of Jira for project management, issue tracking, and workflow automation. This role requires a comprehensive understanding of Jira’s features, configuration, and best practices, along with effective communication and critical thinking skills.

• Installation and Configuration: Setting up and configuring Jira software according to the VA requirements, including infrastructure Setup and configuration.
• System Maintenance: Performing regular system maintenance tasks, such as upgrading Jira software, applying patches and updates, and monitoring system performance.
• Plugin Upgrades and Maintenance: Upgrade all plugins on a scheduled timeline always ensuring system compatibility.
• Security and Access Control: Implementing and maintaining security measures to protect Jira data and ensuring appropriate access controls are in place.
• Performance Optimization: Monitoring system performance, identifying bottlenecks, and implementing optimizations to improve Jira’s speed and efficiency.
• Integration: Creating and maintaining integration with other Atlassian and non-Atlassian tools.
• Troubleshooting: Actively manage system level troubleshooting, working in conjunction with Atlassian support to provide quick and robust resolutions to ensure at most uptime of the system.
• Provide insights into Atlassian functionality to the PMO Hub functional team.
• Automations: Create automations to perform system hygiene, system level reporting to ensure healthy application environment.
• Candidate must have the ability to:
• Create, update and maintain projects and spaces within Jira and Confluence using standard templates.
• Write custom JQL (Jira Query Language).
• Create advanced dashboards in Jira using creativity and advanced JQL.
• Create and maintain Kanban, scrum boards, and customize them to project needs.
• Create and manage complex workflows within Jira.
• Perform user management daily.
• Perform low to medium complexity Jira and Confluence configurations.
• Identify opportunities to enhance and/or standardize tools and templates.
• Support the maintenance/update of existing training materials.
• Pursue opportunities to develop existing skills and to upskill outside of your comfort zone, both personally and for the PMO Hub in general.
• Effectively communicate and set correct expectations with the client as well as internal team.
• Create reporting dashboards of reporting tools like Tableau, Power BI, and Alteryx.
• Create, edit and understand MS Project, Excel, Word, and PowerPoint; and,
• Implement SDLC Methodologies like Waterfall, Agile Scrum and Scaled Agile Framework.

Demonstrates thorough abilities and/or proven record of success in the following areas:

• Understanding of and ability to manage Jira and Confluence configurations to effectively execute the day-to-day activities for the project management standardized services team.
• Identifying opportunities to enhance and/or automate tools and templates, and assist with the research and evaluation of those opportunities to drive standardized delivery of service offerings; and,
• Creatively addressing business challenges using software tools, software development or coding.
• Managing projects with effective prioritization/time management skills to manage multiple projects simultaneously.
• Using written and verbal communication skills, including problem/conflict resolution.
• Exercising appropriate judgment regarding confidential and sensitive information; using judgment to see the long-term impact of issues/ideas.
• Using technology to enhance, automate. and/or standardize processes to increase efficiency.

Qualifications

Required Skills and Experience

• Bachelor’s with 12+ years experience
• Display advanced knowledge of agile delivery and multiple agile approaches.
• Possess excellent communication and written skills, with ability to engage and discuss with stakeholders.
• Expertise with Agile and Scrum Frameworks and their application in Product Development and delivery.

Clearance Required : Ability to obtain and maintain a Suitability/Public Trust Clearance

Company Overview

GovCIO is a team of transformers–people who are passionate about transforming government IT. Every day, we make a positive impact by delivering innovative IT services and solutions that improve how government agencies operate and serve our citizens.

But we can’t do it alone. We need great people to help us do great things – for our customers, our culture, and our ability to attract other great people. We are changing the face of government IT and building a workforce that fuels this mission. Are you ready to be a transformer?

We are an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, gender, gender identity or expression, sexual orientation, national origin, disability, or status as a protected veteran. EOE, including disability/vets.

Posted Pay Range

The posted pay range, if referenced, reflects the range expected for this position at the commencement of employment, however, base pay offered may vary depending on multiple individualized factors, including market location, job-related knowledge, skills, education, experience, and internal equity. The total compensation package for this position may also include other compensation elements, to be discussed during the hiring process. If hired, employee will be in an “at-will position” and the GovCIO reserves the right to modify base salary (as well as any other discretionary payment or compensation program) at any time, including for reasons related to individual performance, GovCIO or individual department/team performance, and market factors.

Posted Salary Range

USD $140,000.00 – USD $180,000.00 /Yr.