Provide analytical support and leadership for internal Operations projects
Work with Operations departments to ensure regulatory and compliance deliverables are met
Represent operations on cross-functional project work teams
Submit, monitor and prioritize IT tickets for operations departments
Review special projects and identify issue trends and potential resolutions
Assist with reporting and processes related to regulatory deadlines
Develop, draft, and review P&P’s and job aides for Operations
Educate/train Business Partners on operations functions
Research and resolve provider claim issues and escalations
Perform analysis of claims data to support Claims management
Ensure timely submission of Regulatory Reporting required by state and federal agencies

Bachelor’s degree or equivalent years of relevant work experience
Minimum of two (2) years of healthcare operations environment
Regulatory and/or compliance experience preferred
Advanced level experience in Microsoft Word, Excel and PowerPoint
Data analysis and trending skills
Demonstrated understanding of claims operations specifically related to managed care
Advanced knowledge of coding and billing processes, including CPT, ICD-9, ICD-10 and HCPCS coding

Operations Regulatory Specialist II

Key skills