Performance Measurement Specialist I - Health Plans

Company: Sentara
Location: Virginia Beach
Posted on: January 24, 2023

Job Description:

City/StateVirginia Beach, VAOverviewWork ShiftFirst (Days) (United States of America)Sentara Healthcare is currently seeking a full-timePerformance Measurement Specialist Ifor Sentara Health Plans-Virginia Beach, VASentara Benefits:Sentara employees strive to make our communities healthier places to live. We're setting the standard for medical excellence within a vibrant, creative, and highly productive workplace. For more information about our employee benefits, https://www.sentaracareers.com/explore-sentara/benefits/Required Education:High School Diploma or EquivalentJob Requirements:

• 3 years experience in Claims Processing, Customer Service, Enrollment, or System Administration required
• 3 years of Accounting/Auditing requiredJob Summary:The position is responsible for the execution of operations random and focused audits. Assess company operations, processes, compliance, and other associated risks. Prepare and present quality reports of audit findings and recommendations to the 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.Join our team, where we are committed to quality healthcare, improving health every day, and providing the opportunity for training, development, and growth!keywords: #Indeed, Monster, Talroo-NCP and entry-level, LinkedIn, Health Plans, insurance, Optima, Virginia Premier, claims processing, customer service, CSR, enrollment, system administration, focus audits, compliance, risk, strategic, CMS, DMAS, groupJob SummaryThe 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 requiredQualifications:HS - High School Grad or Equivalent (Required)Accounting/AuditingSkillsCommunication, Instructing, Microsoft Office, SpeakingSentara 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.

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