Business Operations Specialist - LHB
Luminare Health · United States
- Hybrid
- Full-time
- $71,150 / year
- United States
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Job highlights
- Maintain policies and procedures for regulatory compliance.
- Analyze data to recommend operational improvements.
- Collaborate with operations for efficiency and compliance.
- Research and maintain knowledge of regulatory standards.
- Support departmental needs and provide expertise.
About the role
Job Summary
The Specialist is responsible for the maintenance, revision, and implementation of Policies and Procedures to ensure compliance with applicable regulatory standards and contractual obligations. They will be responsible to prepare, develop and make recommendations by analyzing reports and operational data to support operational improvements and enforcement of established standards. In this role, the Business Specialist will work collaboratively with overall operations management team to develop operational efficiencies, maintain contractual requirements, and overall compliance of core operations is in conformity with various rules and regulations.Key Responsibilities
- Maintains compliance with all applicable regulatory requirements.
- Effectively prioritizes projects to ensure the highest level of customer satisfaction for PSERS Regulatory and Quality Improvement Activities.
- Conducts continual research of new and revised accreditation and regulatory standards applicable to CMS in collaboration with external PSERS vendors.
- Maintains a database of regulatory requirements applicable to PSERS processes.
- Responsible for the ongoing maintenance and revision of PSERS Division and Utilization Management Policy.
- Acts as the Department Liaison for maintenance of required Regulatory Filings/Reports and CMS Inquiries.
- Collects, analyzes and reports on key metrics inclusive of identifying trends, barriers, conducting root cause analysis when applicable and providing objective recommendations.
- Recommends process improvements for every day operating procedures.
- Assists with the ongoing analysis of the PSERS Program to identify opportunities for process improvement, reengineers processes to improve efficiencies and to ensure compliance.
- Provides expertise in regulatory/accreditation issues/inquiries for all PSERS functional areas.
- Maintains a positive and educational approach when interacting with both internal and external customers in explaining the Regulatory Compliance Program wants and needs.
- Assists with the orientation of personnel and positively contributes to the ongoing networking of expertise with colleagues.
- Compiles information via data sources and provides back up support for system administration collecting, analyzing, and summarizing information.
- Works collaboratively with management team to work on identified trends and issues for short term and long term resolution, leveraging people, process, technology, and team communications/tools are updated.
- Coordinates processes to ensure that information systems support departmental business operational needs.
- Promptly review Medicare Part A/D changes and determine impact to PSERS operations. Share the information with operational team and assess impact, implementing changes as needed, to ensure proper tools and educational information is shared with front line team members or impacted individuals.
- Review eligibility and customer service audits, as well as Medicare program audits, to assess steps needed to be taken to correct issues, report and respond to CMS.
- Serves as the first point of contact for coworkers and departmental liaisons regarding the use of designated systems.
- Provides support for the Director of Operations, System Administrator, and Documentation specialist.
- Other duties as needed/assigned.
Required Job Qualifications
- High School Diploma
- Minimum three to five years’ experience with insurance operations, business or technical experience specific to claims, customer service or enrollment.
- Ability to work in a fast-paced, customer service & production driven environment.
- Excellent verbal and written communication skills.
- Ability to work effectively with employees/members, providers, and differing levels of co-workers and all levels of staff.
- Ability to use common sense understanding to carry out instructions furnished in oral, written or diagram form.
- Flexible; open to continued process improvement.
- Self-directed individual who works well with minimal supervision.
- Good leadership, organizational and interpersonal skills.
- Ability to give direction and provide feedback.
- Demonstrated critical thinking skills.
- Ability to effectively deal with problems in varying situations and reach resolution.
- Ability to learn new/proprietary systems, to adapt to various system platforms, and to effectively use MS Excel/Word.
- Previous working knowledge of Medicare and CMS regulations.
Preferred Job Qualifications
- Self-Funded or Fully-Funded Insurance/Benefits and/or TPA experience.
- Previous leadership experience.
Key skills/competency
- Business Operations
- Policy and Procedure Development
- Regulatory Compliance
- Data Analysis
- Process Improvement
- Medicare Regulations
- CMS Regulations
- Operational Efficiency
- Customer Service
- Problem-Solving
Skills & topics
- Business Operations Specialist
- Operations Management
- Regulatory Compliance
- Policy Development
- Data Analysis
- Process Improvement
- Medicare
- CMS Regulations
- Insurance Operations
- Customer Service
How to get hired
- Tailor your resume: Highlight experience in insurance operations, claims, customer service, or enrollment, and emphasize Medicare/CMS regulation knowledge.
- Showcase relevant skills: Emphasize strong communication, critical thinking, problem-solving, and adaptability in your application and during interviews.
- Demonstrate understanding: Prepare to discuss your experience with policy maintenance, data analysis, and process improvement initiatives.
- Prepare for behavioral questions: Be ready to provide examples of how you've handled problems, worked independently, and collaborated with teams.
- Research Luminare Health: Understand their commitment to employee development and their role in the healthcare industry.
Technical preparation
Master MS Excel for data analysis and reporting.,Familiarize with Medicare and CMS regulations.,Practice analyzing operational data for trends.,Understand policy/procedure documentation processes.
Behavioral questions
Describe a time you improved an operational process.,How do you handle conflicting priorities effectively?,Give an example of your problem-solving skills.,How do you ensure regulatory compliance in your work?
Frequently asked questions
- What are the key responsibilities of a Business Operations Specialist at Luminare Health?
- The Business Operations Specialist at Luminare Health is primarily responsible for maintaining and updating policies and procedures to ensure compliance with regulatory standards and contractual obligations. This includes analyzing operational data, recommending improvements, and collaborating with the operations management team to enhance efficiency and compliance. You will also be involved in researching regulatory changes, managing a database of requirements, and acting as a liaison for regulatory filings and inquiries.
- What qualifications are essential for the Business Operations Specialist role at Luminare Health?
- Essential qualifications include a High School Diploma, three to five years of experience in insurance operations (claims, customer service, or enrollment), and a strong understanding of Medicare and CMS regulations. Candidates should also possess excellent communication skills, the ability to work in a fast-paced environment, strong critical thinking abilities, and proficiency with MS Excel/Word. Flexibility and a self-directed work style are also important.
- Does Luminare Health offer opportunities for professional development for a Business Operations Specialist?
- Yes, Luminare Health emphasizes employee growth through curated development plans. As a Business Operations Specialist, you can expect investment in your professional development to foster a rewarding and fulfilling career within the company.
- What kind of work environment can I expect as a Business Operations Specialist at Luminare Health?
- You can expect a fast-paced, customer service, and production-driven environment. Luminare Health values a collaborative approach, and you will work closely with the overall operations management team and other staff members. The company also promotes a positive and educational approach in interactions with both internal and external customers.
- How important is knowledge of Medicare and CMS regulations for this role?
- Knowledge of Medicare and CMS regulations is crucial for the Business Operations Specialist role. You will be responsible for maintaining compliance with these regulations, researching new standards, managing a database of requirements, and acting as a liaison for CMS inquiries. Experience with these regulations is a required qualification.
- What are the preferred qualifications for a Business Operations Specialist at Luminare Health?
- Preferred qualifications include experience with Self-Funded or Fully-Funded Insurance/Benefits and/or TPA (Third-Party Administrator) experience. Previous leadership experience is also considered a plus for this role.
- How does Luminare Health support its employees outside of work?
- Luminare Health offers a robust total rewards package, including health and wellness benefits, a 401(k) savings plan, pension plan, paid time off, paid parental leave, disability insurance, supplemental life insurance, an employee assistance program, paid holidays, and tuition reimbursement.