Performance Measurement Specialist II

City/State

Richmond, VA

Overview

Work Shift

First (Days) (United States of America)

Sentara Healthcare is currently hiring a Performance Measurement Specialist II for Virginia Premier!

This is a Full Time position with day shift hours and great benefits!

Remote opportunities available in the following states: Virginia, North Carolina, Florida, Nevada, Wyoming, South Dakota, Washington and Indiana, Georgia, South Carolina, Tennessee, Texas, West Virginia, Wisconsin, Maryland.

Sentara Healthcare offers employees comprehensive health care and retirement benefits designed with you and your family's well-being in mind. Our benefits packages are designed to change with you by meeting your needs now and anticipating what comes next. You have a variety of options for medical, dental and vision insurance, life insurance, disability and voluntary benefits as well as Paid Time Off in the form of sick time, vacation time and paid parental leave. Team Members have opportunity to earn an annual flat amount Bonus payment if established system and employee eligibility criteria is met.

For applicants within Washington State, the following hiring range will be applied: $43,942 annually to $65,913 annually.

Job Requirements:

• High School Diploma
• 3 years experience in Auditing
• 3 years experience in Claims Processing
• Health Care experience Preferred
• Bachelors Degree Preferred

Primary responsibilities include:

• Responsible for the execution of operations random and focus audits
• Assess company operations, process, compliance and other associated risks
• Prepare and present quality reports of audit findings and recommendations to Manager and customers
• Develop strategic initiatives to maintain and improve the audit function
• Evaluate and revise internal controls and operational and management policies/procedures. Support External Audits for CMS, DMAS, and Groups

Sentara Health Plans is the health insurance division of Sentara Healthcare doing business as Optima Health and Virginia Premier.

Sentara Health Plans provides health insurance coverage through a full suite of commercial products including consumer-driven, employee-owned and employer-sponsored plans, individual and family health plans, employee assistance plans and plans serving Medicare and Medicaid enrollees.

With more than 30 years' experience in the insurance business and 20 years' experience serving Medicaid populations, we offer programs to support members with chronic illnesses, customized wellness programs, and integrated clinical and behavioral health services - all to help our members improve their health.

Benefits: Sentara offers an attractive array of full-time benefits to include Medical, Dental, Vision, Paid Time Off, Sick, Tuition Reimbursement, a 401k/403B , 401a, Performance Plus Bonus, Career Advancement Opportunities, Work Perks and more.

Our success is supported by a family-friendly culture that encourages community involvement and creates unlimited opportunities for development and growth.

Be a part of an excellent healthcare organization that cares about our People, Quality, Patient Safety, Service, and Integrity. Join a team that has a mission to improve health every day and a vision to be the healthcare choice of the communities that we serve!

Keywords: Auditing, Claims Processing, Performance Measurement, Health Plan

Job Summary

The position is responsible for the execution of operations random and focus audits. Assess company operations, process, compliance and other associated risks. Prepare and present quality reports of audit findings and recommendations to Manager and customers. Develop strategic initiatives to maintain and improve the audit function. Evaluate and revise internal controls and operational and management policies/procedures. Support External Audits for CMS, DMAS, and Groups .

3 years experience in Claims Processing, Customer Service, Enrollment or System Administration required

Qualifications:

HS - High School Grad or Equivalent (Required)

Accounting/Auditing

Skills

Communication, Instructing, Microsoft Office, Speaking

Sentara Healthcare prides itself on the diversity and inclusiveness of its close to an almost 30,000-member workforce. Diversity, inclusion, and belonging is a guiding principle of the organization to ensure its workforce reflects the communities it serves.

Per Clinical Laboratory Improvement Amendments (CLIA), some clinical environments require proof of education; these regulations are posted at ecfr.gov for further information. In an effort to expedite this verification requirement, we encourage you to upload your diploma or transcript at time of application.

In support of our mission "to improve health every day," this is a tobacco-free environment.