Overview The Registered Nurse provides nursing care to individuals and groups which require specialized knowledge, judgment, and skill derived from the principles of biological, physical, behavioral, social, spiritual/cultural, and nursing sciences. The Registered Nurse functions within the full scope of nursing practice as noted by the Board of Nursing of their designated state for which they are practicing in addition to compliance with any of the hospitals accrediting bodies.
Full-Time
Level: Mid
Travel: No
SuccessProfile Who is the ideal Promedica employee? We're looking for people to join our team who are motivated by making an impact and doing meaningful work.
Responsible 10
Compassionate 9
Communicator 9
Adaptable 9
Multi-tasker 8
Additional success profiles:
Detail oriented, Flexible, Helpful, Patient, Responsible, Sincere, Understanding
Benefits
Professional Growth
Retirement & Savings Plan
Innovative Training Programs
Tuition AssistanceCareer Stability
Comprehensive Health Coverage
Job Requirements
ProMedica’s health plan, Paramount Insurance, offers health insurance products across six Midwest states. Paramount is an Ohio-based health insurance company, headquartered in Toledo. The organization has more than 800 employees dedicated to serving their health plan members.
Paramount offers Medicare Advantage and Marketplace Exchange health plans for individuals and families. Paramount maintains accreditation by the National Committee for Quality Assurance (NCQA) for their HMO and Medicare Advantage products.
In addition, Paramount has a full complement of insurance products for employers of any size, including medical, dental, vision and workers’ compensation, as well as vocational rehabilitation, life-care planning and wellness.
As a part of ProMedica, Paramount is driven by ProMedica’s mission to improve your health and well-being. ProMedica has been nationally recognized for its advocacy programs and efforts to address social determinants of health. Paramount strives to provide an exceptional experience to every member. For more information about Paramount, please visit our website. .
Position Summary
The Claims and Configuration Operations Specialist is responsible for the overall direction, coordination, implementation, execution, control, and completion of projects in a multi-functional environment.  This role will be expected to work directly and collaboratively with Paramount leadership and ProMedica leadership in the attainment of strategic priorities.  Will be expected to work directly and independently with vendors and providers.
Accountabilities
• Communicate and engage with key stakeholders and department leads on complex issues pertaining to benefit configuration processing, claims processing, pricing configuration processing, quality assurance implementation, and policy, procedure, and workflow coordination.
• Creates project trackers with timelines, action items, and resources.
• Develop and manage reports related to Key Performance Indicators and productivity across all departments within Operations.
• Managing projects from beginning to end and assisting with other projects as needed.
• Analyzes, designs, and implements improved work systems, procedures, reconciliation and quality assurance processes and methods.
• Performs and/or assists with the implementation of new systems and methods.
• Manage specified operational responsibilities on an ongoing basis.
• Performs analytical duties as assigned.
• Assists with implementation of process or reporting changes for regulatory reasons or special regulatory audits.
• Assists with the implementation or reconfiguration of processes due to strategic initiatives or other reasons.
• Work closely with Paramount leadership as needed for applicable strategic initiatives.
• Other duties as assigned.
• Education: Bachelor’s degree required
• Skills: Possess strong skills in planning, organization, and an understanding of claim work flows, quality assurance processes, internal controls, and health plan benefit configuration.
• Must possess excellent communication, ability to foster collaboration and cooperation, motivation, analytical, problem solving and project management skills.
• Must have analytical skills capable of analyzing complex data sets and identifying trends and other key performance indicators in the data.
• Must influence stakeholders to change existing processes to maximize efficiencies.
• Must be proficient in Microsoft Office.
• Ability to communicate on telephones, operate computers and general office equipment.
• Years of Experience: Minimally 2 years’ experience in an areas such as project management, claims processing, coding and configuration, healthcare, insurance, or process design setting.
Preferred Qualifications
• Education: Master degree preferred
• Years of Experience: 3-5 years of experience of project management or managing people and technology toward optimal processes is preferred.
• Certified Professional Coder (CPC) through the American Academy of Professional Coders (AAPC) or Certified Coding Specialist (CCS) through the American Health Information Management Association (AHIMA)
• Registered Health Information Administrator through AHIMA or Registered Health Information Technician through AHIMA
ProMedica is a mission-based, not-for-profit integrated healthcare organization headquartered in Toledo, Ohio.  For more information, please visit www.promedica.org/about-promedica
Qualified applicants will receive consideration for employment without regard to race, color, national origin, ancestry, religion, sex/gender (including pregnancy), sexual orientation, gender identity or gender expression, age, physical or mental disability, military or protected veteran status, citizenship, familial or marital status, genetics, or any other legally protected category. In compliance with the Americans with Disabilities Act Amendment Act (ADAAA), if you have a disability and would like to request an accommodation in order to apply for a job with ProMedica, please contact employment@promedica.org
Equal Opportunity Employer/Drug-Free Workplace
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