For roles that are 100% remote or hybrid, you must have access to a reliable high-speed internet connection to support daily job responsibilities. A minimum bandwidth of 50 Mbps download and 5 Mbps upload is required. Those fully remote associates residing in states where service is required by contract, law, or regulation will be allowed to submit for reimbursement.
Responsibilities:As part of the Pennsylvania Community Health Choices (CHC) health plan team, the Operations Reporting Analyst Supervisor is responsible for the oversight of and leadership for the Operations Reporting Analyst team and reporting deliverables.
The Operations Reporting Analyst team is responsible for the completion of the Service Coordination and other business area components of our regulatory operations reporting process through the completion, improvement and validation of existing state mandated reporting requirements while maintaining a high level of accuracy, integrity and timeliness of data reports.
Principal Accountabilities:- Fosters team engagement and growth through consistent coaching, mentorship, and performance evaluations, supporting career development while addressing performance gaps in a timely and effective manner.
- Executes organizational efforts in ongoing quality improvement processes to ensure compliance with State, Federal, regulatory and accrediting body's standard requirements and statutory reporting policies and procedures.
- Develops and maintains a complete understanding of all data sources available for reporting on CHC Service Coordination and other related requirements..
- Develops and maintains strong knowledge of business practices and the managed care industry in general and applies knowledge to determining data and report solutions.
- Leads team in completing all regulatory reporting requirements assigned, accurately and meeting all deadlines. Failure to do so may result in the company incurring financial penalties, decreased satisfaction by regulator/stakeholders, and compromised relationship with state or other regulatory agencies.
- Conducts audits of all Operation Reports including data validation, documentation, quality and timeliness using trending, benchmarking or other analyses to ensure data integrity.
- Maintains electronic and paper documentation supporting the completion of each report for each reporting period within departmental guidelines.
- Identifies, resolves and/or escalates problematic Ops Reporting areas that may place plan at risk of not achieving ongoing goals.
- Leads team in ensuring reporting is accurate and timely, as well as identifies and researches problem areas that potentially compromise accuracy or integrity of the data reported.
- Serves as a resource to other departments in completing Ops Reporting requirements and goals.
- Works professionally, collaboratively and efficiently with all functional areas in meeting organizational and departmental goals.
- Responsible for providing input into the development of Ops Reporting projects and accountable for the execution and documentation of those projects ensuring identification of root cause; with the assistance of the CHC Health Plan and Regulatory Reporting leadership to establish work plans to implement interventions.
- Leads team in the implementation of interventions aimed at improving quality performance.
- Responsible for creation and submission of state reporting documentation of activities and projects within his/her scope of responsibility and in collaboration with leadership and Regulatory Reporting.
- Uses data and analysis tools to identify opportunities for improved performance and collaborates with the team, Service Coordination leadership, health plan leadership and Regulatory Reporting to develop intervention strategies.
- Removes barriers to achieve successful completion of strategic projects.
- Conducts analysis and provides summary reports and insights to senior management.
- Other duties as assigned.
General:- Works in a collaborative manner with all providers, members, departments within the AmeriHealth Caritas Family of Companies to conduct ongoing process and data review to identify opportunities for improvement.
- Performs ad-hoc analysis of any underperforming or "broken" processes by collaborating with Subject Matter Experts and/or Customers to define existing processes and make recommendations for improvement.
- Responsible for the management and development of new and existing staff.
Education/ Experience:- Bachelor's Degree
- 1 to 3 yearsleadership experience.
- Minimum of 3 years in service quality improvement or service coordination required.
- Minimum of 3 years in human service delivery required.
- Proficient PC skills in a windows-based environment, with a strong emphasis on demonstrated moderate-to-expert proficiently using Microsoft Excel.
- Excellent organizational, analytical and interpersonal skills.
- Excellent written and verbal communication skills.
Preferred:- Managed Care Organization (MCO)/health plan experience.
- Advanced/expert proficiency in MS Excel and other data validation tools(MS Access, Power BI or other platforms).
- Direct, applicable experience in the PA Community HealthChoices (CHC) or HealthChoices (HC) Medicaid programs.
- Location in the greater Philadelphia metro area.
Work Arrangement:- Remote, some travel required
- Qualified candidates must live in EST time zone
Our Comprehensive Benefits PackageFlexible work solutions including remote options, hybrid work schedules, Competitive pay, Paid time off including holidays and volunteer events, Health insurance coverage for you and your dependents on Day 1, 401(k) Tuition reimbursement and more.
