Performance Measurement Specialist I

Location
Virginia Beach, VA
Posted
Aug 30, 2018
Closes
Sep 17, 2018
Function
Nurse
Industry
Healthcare
Hours
Full Time
Job Description: The position is responsible for providing hands on training to the Customer Operations Department as well as other departments as needed. The Performance Measurement Analyst serves as a resource for the Customer Operations staff and external departments, providing on-going and consistent training as required. Performs random and focused audits relative to all operational functions within Customer Operations. Education Level
High School Grad or Equivalent

Experience
Required: Training - 2 years

Preferred: None, unless noted in the “Other” section below

License
None, unless noted in the “Other” section below

Skills
Required: Communication, Instructing, Microsoft Office, Speaking

Preferred: None, unless noted in the “Other” section below

Other
2 years experience in Claims Processing, Customer Service, Enrollment or System Adminstration required

Optima Healthcare is currently recruiting for a Performance Measurement Specialist to work in their Virginia Beach location!

Minimum 2 years Training experience in the Customer Operations field
*2 years experience in Claims Processing, Customer Service, Enrollment or System Administration required

Shift - Day shift, M-F. Full Time - 40 hrs/wk
Location: Virginia Beach Blvd. and Witchduck Rd. area

Optima Health Community Care is hiring an Authorizations Secretary
to join our Government LTSS/Authorizations team in Norfolk, VA.

Hours/Shift:

Monday - Friday, 8am-5pm 

Department/Position Overview:

The ideal candidates are familiar with the medical preauthorization process and may have experience in providers offices making the prior authorization request to an Insurance Plan.  In addition, independent judgment skills and ability to prioritize and handle multiple time-sensitive requests is a must.

•Ability to work in a fast-paced environment while seated in a work station and wearing a headset.
•Ability to accept incoming provider calls while completing another task.  (multi-tasking)
•Ability to quickly learn and navigate multiple computer systems using dual monitors.
•Ability to adapt to changes in process
•Detailed in all aspects of work
•Excellent customer service skills both to external customers and internal customers
•Ability to work on a team but also function independently
•Ability to recognize the importance of prior authorization and its impact on the provider and the member affected
•Familiarity with Medical Terminology
•Previous health insurance companies is a plus.
Division Highlights:

Optima Health Community Care is a Commonwealth Coordinated Care Plus (CCC Plus) Medicaid plan for many older people and those with disabilities. CCC Plus is a Medicaid managed care program through the Virginia Department of Medical Assistance Services (DMAS).

With Optima Health Community Care, members benefit from an individualized, fully-integrated program with a state-wide network of providers. As an Optima Health Community employee, you will join a care team committed to providing customized and personalized support and services in the community that our members can count on. Optima Health is a service of Sentara Healthcare, so joining Optima is joining the Sentara Healthcare family.

Sentara 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.
Join our team, where we are committed to quality healthcare, improving health every day, and provide the opportunity for training, development, and growth!

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