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- Collaborate with business stakeholders, external vendors and/or government entities to resolve reported and operational incidents and test technical changes.
- Promptly monitor, assign, and work through incidents and requests, based on priority and ensure that service level targets are met.
- Perform root cause analysis and contribute to remediation planning and implementation.
- Communicate cause, status, and solution to appropriate internal and external stakeholders.
- Document service tickets and ensure that technical documentation is consistent with the technical implementation at the point of production deployment and incident resolution.
- Write and execute an appropriate test plan for the level of complexity of the solution and work with Quartz Data Warehouse team members to remediate operational and report incident.
- Moderate to complex impact analysis and troubleshooting.
- Complete impact assessments and ad hoc analyses to ensure that production issues and other reported deficiencies are understood and resolved by updating requirements.
- Understand source and target data structures, using standard data tools to review required data and fully profile the data to analyze the impact on downstream data processes, external data submissions, and Quartz business.
- Review requirements, technical specifications, and data models and update appropriately based upon final remediation.
- Perform data validation and testing for technical changes and process improvements.
- Map source system data to data warehouse models.
- Work closely with Quartz Data Warehouse team members to fully resolve operational and reported issues.
- Test final resolutions and ensure that the implementation meets business requirements and service level targets.
- Deposits checks received for provider refunds, claims, and premiums for multiple entities using remote deposit capture
- Maintains cash deposit logs, including, but not limited to, finance, claims, and recoveries
- Scans documents for imaging
- Completes Schedule A form 5500’s as requested by employer groups
- Prints weekly pay cycle vendor checks
- Stuffs and mails checks, including inserts and remittances as needed
- Creates, reconciles, and uploads agency commissions data to self-serve data platform
- Creates monthly DHS payment statements
- Reconciles vendor statements
- Processes and logs checks and mail returned to Finance by USPS
- Assists with month-end financial close tasks and perform basic general ledger account reconciliations
- Assists accounts payable team as needed including invoice processing and other miscellaneous tasks
- Collects Forms W9 for 1099 reporting and assists with quarterly 1099 reconciliations
Perform designated executive support duties requiring judgment, initiative, and knowledge of office functions for the designated executive(s)/ director(s). Responsible for providing excellent quality service and maintaining excellent working relationships for internal and external customers. This may include such duties as:
- Schedule internal and external meetings/events and appointments via Outlook for leaders as requested (includes scheduling, room reservations, equipment set up and catering orders). Proactive maintenance of calendars.
- Prepare, compose, and type letters/memos/emails, graphs, charts, studies, presentations, miscellaneous reports, and research for assigned leader.
- Prepare and distribute meeting agendas and materials and attend meetings and take minutes as assigned. Transcribe minutes with appropriate follow-up on action items.
- Screen and direct telephone calls, mail, and email to the appropriate person within the organization. Obtain appropriate signatures as needed and requested on documents/contracts/agreements.
- Make purchase orders as needed, reconcile company credit card, allocate purchases to appropriate budget cost centers, create expense reports and help others troubleshoot fiscal processes.
- Excellent active listening skills
- People-oriented, with the ability to show empathy and compassion, along with the willingness to be helpful
- Ability to multitask – specifically able to operate computers and telephones simultaneously in a fast-paced environment along with the ability to learn and navigate through multiple computer applications
- Excellent written and verbal communication skills
- Works well in a team environment and independently as a telecommuter
- Excellent attendance record
- Serve as the primary point of contact for reporting, analytics, and insights across Quartz and provider sponsors
- Collaborate with executive colleagues and other stakeholders on data-driven initiatives and analyses
- Oversee prioritization of key data-related initiatives for Quartz, provider sponsors, and any other stakeholders, including identifying opportunities, considerations, and actions for the bi-directional exchange of data between organizations that drive improvement, cost savings, and efficiencies
- Empower and build a high-performing team of data professionals who understand Quartz’s culture, objectives, and strategies to apply effective data analyses and expertise to address organizational concerns, challenges, risks, and opportunities.
- Assess the organization’s current capabilities and develop a strategic plan to address any gaps or challenges.
- Prioritize data quality, data reporting, data requests, and data needs to ensure accurate and useful business outcomes and actionable insights for Quartz, provider sponsors, and other stakeholders
- Design, develop, and maintain functional data repositories for operational and production data from the data warehouse and other vendor data sources
- Promote effective teamwork and actively eliminate impediments to collaboration between departments and between Quartz and its provider sponsors
- Enhance Quartz’s enterprise-wide data and reporting capabilities
- Optimize technology in the data space to create a competitive advantage within the healthcare and health insurance industries
- Promote data literacy and a companywide data-driven culture
- Establish policies and practices that improve user access to data while ensuring data quality, credibility, protection, and privacy through effective data governance
- Excellent active listening skills
- People-oriented, with the ability to show empathy and compassion, along with the willingness to be helpful
- Ability to multitask – specifically able to operate computers and telephones simultaneously in a fast-paced environment along with the ability to learn and navigate through multiple computer applications
- Excellent written and verbal communication skills
- Works well in a team environment and independently as a telecommuter
- Excellent attendance record
- Perform comprehensive market analysis across a variety of geographic markets to include competitive analysis, customer segmentation, SWOT analysis, demographic/behavioral insights, etc.
- Interpret data to provide meaningful reports aligned with strategy objectives that will enable smart growth.
- Support qualitative and quantitative market research projects by analyzing, interpreting, and reporting key finding to cross functional stakeholders.
- Support Voice of the Customer program by analyzing and interpreting both experience and operational data to develop meaningful reports that lead to actionable positive outcomes for the customer.
- Review sales, marketing, and product concepts to define help define pain points and strategic objectives. Develop knowledge of multiple business areas, including understanding the business terminology, processes, and organization structure to provide more informed deliverables.
- Identify business requirements and implement policies and procedures to ensure continued compliance with state and/or federal requirements of the Individual ACA and Small Group ACA product lines.
- Provide product subject matter expert support to QHP template owners and drive key filing deliverables for timely completion. Collaborate with audit for review and preparation of the QHP Application materials prior to submission to CMS or appropriate state regulators. Responsible for the annual QHP Application submission and Small Group ACA binder filings in accordance with the deadlines set in the final Letter to Issuers and state bulletins.
- Develop, maintain, and manage Individual and Small Group ACA product documents to support the annual Open Enrollment Period, including but is not limited to Quartz public web-pages, enrollment materials and member letters, internal reference documents and data tables, and marketing materials.
- Analyze Key Performance Indicators and make recommendations that drive product performance.
- Complete monthly and quarterly enrollment reporting to state and federal regulators and perform analysis on incoming files from CMS and coordinate operations efforts to implement any enrollment changes/updates required.
- Review, edit and adjudicate claims that are pended and/or assigned in HealthLink based on CES logic/application, regulatory and internal policies.
- Research and resolve assigned claim pends, review and monitor daily trends.
- Research and respond to Customer Relationship Management (CRMs) inquires routed for coding expertise.
- Review and resolve appeals in OnBase or HealthLink by reviewing documentation and making determination.
- Serve as a subject matter expert to advise internal and external parties on correct and compliant coding regulations and requirements for professional and facility coding and billing practices.
- Edit, adjudicate, and resolve claim pends assigned from CES logic.
- Monitor and analyze coding patterns to identify potential risks and assist with special projects to address trends, financial impacts, and potential improvements to system and performance and operational capabilities.
- Develop and update claim coding policies, procedures, and supporting documentation.
- Monitor industry standards and regulatory updates, analyzing and communicating impacts or changes that may be required to Quartz operations and lines of business.
- Manage several complex projects, with complex resources interdependencies, concurrently. Function as the primary resource in all phases of the projects and adds value as a Subject Matter Expert (SME) to project subject matter. Provider leadership to coordinate the efforts of the team and assist with decision making to successfully complete projects on time, within scope, and authorized budgets This includes the following responsibilities:
- Work with Project Business owner to decide the appropriate project approach or combination of approaches (waterfall, agile, Lean Six Sigma, etc.) for most effective project delivery.
- Ensure project development activity is customer focused, results oriented, performance driven, and in compliance with all applicable internal and external requirements.
- Consult with project team during plan development and throughout the project to ensure that issues and risks are identified and addressed.
- Work with the team to identify dependencies and interactions between projects and their impacts on an integrated plan.
- Conduct project communication planning: facilitate project teams, and provide updates to oversight team, stakeholders and sponsor.
- Leverage available project management software tools and divisional resources to help plan and manage projects or programs to successful completion. Assists and holds team members accountable for their sections of the overall work plan.
- Collaborate with appropriate subject matter experts to design solutions to meet the requirements of the project.
- Architects, designs, enhances, and supports delivery of data integrations, enterprise data warehouse, data marts, and data submissions.
- Identifies, develops, and documents data acquisition and delivery requirements to meet business and customer needs.
- Facilitates group discussions and join data design sessions with the business area subject matter experts.
- Designs data models and data processing flows for data acquisition, reporting and analysis.
- Develops, implements, and maintains standards and procedures concerning the design and use of data for compilation and delivery.
- Coordinates data solution delivery and supports data analysis and data development staff as necessary in the development and maintenance of data implementations.
- Queries, analyzes, and interprets complex data stored in the source and target systems.
- Play a role in supporting the company’s data governance program to provide definitions, visibility, and access controls for corporate data.
- Works with business stakeholders to assist with data-related technical issues and supports their data infrastructure needs.
- Collaborate with business users, external vendors and/or government entities to obtain data requirements for new analytics applications and data feeds or enhancement of existing products.
- Uncover appropriate sources of data for proposed application or data warehousing extension profiling data to ensure fitness for business purpose.
- Coordinate business requirements for the data and provide consultation to internal stakeholders to support their data needs.
- Understand source and target data structures, using standard data tools to review required data and fully profile the data to analyze its ability to meet the business needs.
- Complete impact assessments and ad hoc analyses to ensure that production issues and other reported deficiencies are adequately understood and resolved by updating requirements.
- Translate requirements into technical requirement specifications, appropriately documenting the solution via Report Specifications, Data Flow Diagrams, and Source to Target (STT) documents.
- Act as a senior analyst by directing junior analysts on company protocols, business data, and technical skill.
- Create and refine tools and workflows to efficiently collect and translate organizational data and reporting needs.
- Collaborate with business users, external vendors and/or government entities to obtain data requirements for new analytics applications and data feeds or enhancement of existing products.
- Uncover appropriate sources of data for proposed application or data warehousing extension profiling data to ensure fitness for business purpose.
- Coordinate business requirements for the data and provide consultation to internal stakeholders to support their data needs.
- Understand source and target data structures, using standard data tools to review required data and fully profile the data to analyze its ability to meet the business needs.
- Complete impact assessments and ad hoc analyses to ensure that production issues and other reported deficiencies are adequately understood and resolved by updating requirements.
- Translate requirements into technical requirement specifications, appropriately documenting the solution via Report Specifications, Data Flow Diagrams, and Source to Target (STT) documents.
- Strategic development of population health and quality improvement approaches and programs, in collaboration with the other Clinical Services leaders to support the goal of improving member health needs and services.
- Drives Clinical Advisory Services in support of Health Plan departments for internal and external stakeholders.
- Keeping abreast of industry trends, interpreting data with a lens of impactable/actionable outcomes and recommending innovative programs and business decisions that drive quality of care and supports value-based care initiatives.
- Day-to-day oversight of quality improvement department.
- Includes program innovation and outcomes monitoring.
- Staff recruitment/retention, development, including coaching, mentoring and performance monitoring.
- Responsible to ensure operations and programs align with regulatory and accreditation requirements, in coordination with the Compliance and other Health Plan departments.
- Membership on health plan committees, such as those responsible for clinical services and quality activities, including Quality Improvement Committee, Sponsor Population Health Committees and others, as assigned by the Chief Clinical Officer.
- Designs, builds, tests, debugs, secures, and deploys usable & scalable solutions in Salesforce leveraging Force.com, VisualForce, Apex, Lightning Web Components, Web Services, APIs, Flows, Experience Cloud sites, and OmniStudio
- Supports Salesforce integration implementations with on-prem, 3rd party and cloud applications
- Attends Agile ceremonies such as daily stand-ups, backlog grooming, sprint planning and provides regular updates to maintain transparency
- Performs peer code reviews as necessary to ensure consistent quality and adherence to best practices
- Creates and maintains technical artifacts such as API specifications and technical programming specifications for the assigned development modules
- Works with product owners, business analysts, architects, and cross-area teams to deliver tailored solutions that meet business requirements and align with business goals
- Participates in requirement analysis & design discussions, offering recommendations to make the best use of Salesforce platform and products
- Creates time estimates for assigned project tasks
- Conforms to security and governance requirements
- Collaborates and shares development tasks with external service vendors
- Provides day-to-day support and troubleshoots production issues ensuring smooth operations and delivery
- Participates in on-call support rotation which includes 24x7 support for critical systems
- Maintain core IT service management processes including but not limited to change, request asset, incident, problem, event, knowledge, and configuration management disciplines.
- Administer service management and collaboration systems, tools, and technologies. Work with external partner(s) to architect, design, implement changes, and perform system maintenance. Adhere to policy, development, processes, and guidelines. Ensure all documentation, policies, and procedures remain current.
- Liaise with Quartz service owners to understand process requirements; gather and create requirements documentation. Develop system architecture and design specifications and visuals of desired state. Conduct gap and change analysis, providing recommendation to service owners and teams for opportunities and changes. Work with service team to develop detailed plan(s) to implement change.
- Create reports, run analytics, and provide system-driven metrics used by leaders and service owners. Conduct analysis and review for trends. Identify and escalate issues. Work with team(s) to recommend improvement areas and associated work plans.
- Provide mentoring and leadership to the IT Service Management team.
- Work directly with IT senior leaders to define the IT Service Management maturity roadmap.
- Participate in the planning and implementation of the operationalization of new or changed services. Provide guidance to end users to access standard IT support and services.