EmblemHealth

Lead Business Operations Support Specialist

EmblemHealth • $90K — $120K *
New York, NY 10025In-Person
Healthcare
5 - 7 years of experience
2 weeks ago
Job Overview by Ladders

Qualifications

  • Bachelor's in Business, Health Administration, or related field; graduate degree preferred.
  • CHC certification or equivalent preferred.
  • 5-8+ years of increasing responsibility in managed care environment.
  • Experience in Healthcare Operations, Accreditation, and Compliance required.
  • Extensive knowledge of CMS, DOH, and DFS compliance requirements.
  • Excellent communication skills across diverse audiences.
  • Technologically literate with IT frameworks and systems.

Responsibilities

  • Develop and oversee annual operations business support work plan.
  • Maintain and update policies for operations regarding Product, Accreditation, and Contracts.
  • Drive implementation of day-to-day operations controls as per industry changes.
  • Act as independent review body to evaluate compliance issues and concerns.
  • Monitor business activities across departments for trends impacting operations.
  • Interface with various teams to manage regulatory audits and compliance events.
  • Act as Operations lead for program audits and conduct risk assessments and corrective actions.
  • Lead process improvement initiatives to enhance efficiency and reduce costs.

Benefits

  • Remote work flexibility.
  • Opportunity for career advancement in a managed care setting.
  • Work on high-impact projects with cross-departmental collaborations.
Full Job Description
REMOTE

Summary of Position
  • Responsible for ongoing business support of the Operational functions, including new or revised product implementations, accreditation, contracts, compliance requirements and internal and external regulatory or client audits.
  • Lead and support implementations of new processes within operations, interfacing with Product, Accreditation, Provider Network Management and Compliance counterparts as well as overseeing and driving initiatives at the direction of the Tower Leads; oversee ongoing progress.
  • Direct and guide operational areas on compliance measures, providing subject matter expertise and guidance for all matters relating to business functions, accreditation/quality and compliance requirements


Principal Accountabilities
  • Develop and oversee annual Operations Business Support work plan, which includes documenting and tracking all initiatives and requirements, assessing projects, timelines and risks.
  • Develop, initiate, maintain and update policies and procedures for the operations aspects of Product, Accreditation, Contracts and those that support regulatory requirements.
  • Drive and direct implementation of day-to-day operations controls. Maintain current knowledge of changes in products, accreditation standards, industry rules and regulations and assist in maintaining effective lines of communication with other departments to ensure alignment.
  • Act as an independent review and evaluation body to ensure that Product, Accreditation, Contractual and compliance issues and concerns are being appropriately evaluated, investigated and resolved.
  • Monitor and oversee business activities of other departments that Operations interfaces with to maintain an end-to-end process view of all products, business, quality and compliance activities and to identify trends that cross-functionally impact the organization.
  • Interface directly with the Operations Audit team, Corporate Compliance, Account Management, Quality and Operations team(s) to manage regulatory audits and monitoring events, accreditation reviews, and internal or client-based audits. Direct universe generation, preparation of sample files and corrective action plans as needed.
  • Act as Operations lead for program audits; proactively prepare Operations, direct Analytics and reporting team on data validation requirements, perform mock audits and assess risks. Work in conjunction with Operations leadership and teams to provide root cause analysis, corrective action plans and execution/implementations therein.
  • Conduct routine meetings with Operational partners and attend other business area meetings, such as Product Implementations, Annual Renewals, NCQA Workgroups and Compliance work groups to serve as an Operations liaison.
  • Actively support and lead process improvement initiatives that lead to cost savings, improved experience and maximization of administrative resources.
  • Lead projects as needed; perform other related tasks as directed or required.


Qualifications

Education, Training, Licenses, Certifications
  • Bachelor's Degree in Business, Health Administration or related field required; graduate degree, preferred. Additional years of experience may be considered in lieu of educational requirements
  • Certification in HealthCare Compliance (CHC) or equivalent preferred


Relevant Work Experience, Knowledge, Skills, and Abilities
  • 5 - 8+ years' experience in positions of increasing complexity/responsibility, preferably in a managed care environment required
  • Experience in Healthcare Operations, Product, Accreditation and/or Compliance required
  • Extensive knowledge of CMS, DOH and DFS compliance requirements required
  • Excellent communication skills (verbal, written, presentation, interpersonal) with all types/levels of audience required
  • Technologically literate - familiar with IT focused frameworks, systems and methodology required
  • Proficient with MS Office (Word, Excel, PowerPoint, Outlook, Teams, Visio, etc.) required

About EmblemHealth

EmblemHealth is a non-profit health insurance company based in New York City. It is one of the largest non-profit health insurers in the United States, serving over 3 million people. EmblemHealth offers a range of health insurance plans, including HMO, PPO, and EPO plans, as well as Medicare and Medicaid plans. The company also offers wellness programs and disease management services. EmblemHealth was formed in 2006 through the merger of Group Health Incorporated (GHI) and the Health Insurance Plan of Greater New York (HIP). The company has offices in New York City and Albany, New York.
Learn more about EmblemHealth
Size
3,000 employees
Industry
Healthcare
Net Income
-$100 million
Founded
2006
5 Year Trend
-5%
Revenue
$10 billion
NASDAQ
* Ladders Estimates

Similar Jobs

Ad banner background

Get Ready For Your
Next Interview

More Jobs at EmblemHealth

More Healthcare Jobs

Find similar Lead Business Operations Support Specialist jobs:

NationwideNew York, NY