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Job Details

Quality Assurance Analyst - Health Insurance Operations

Requisition #: 231663
Location: Johns Hopkins Health Care, Hanover, MD 21076
Category: Clerical and Administrative Support
Work Shift: Day Shift
Work Week: Full Time (40 hours)
Weekend Work Required: No
Date Posted: May 14, 2020

Johns Hopkins HealthCare (JHHC) is the managed care and health services business of Johns Hopkins Medicine, one of the premier health delivery, academic, and research institutions in the United States. JHHC is a $2.5B business serving over 400,000 lives with lines of business in Medicaid, Medicare, commercial, military health, health solutions, and venture investments. JHHC has become a leader in provider-sponsored health plans and is poised for future growth.

Many organizations talk about transforming the future of healthcare, Johns Hopkins HealthCare is actually doing it. We develop innovative, analytics-driven health programs in collaboration with provider partners to drive improved quality and better health outcomes for the members and communities we serve. If you are interested in improving how healthcare is delivered, join the JHHC team.

Position Summary

Provides support to Operations through Quality Assurance (QA) practices and oversight of operations functions. Performs quality audits, conducts feedback sessions and other QA functions for operations staff. Specific areas of focus may be provider maintenance, credentialing, enrollment, COB, claims, customer service, provider relations and/or other areas of operations.

Requirements:


Education:

  • Associates degree in business management, health care administration or related discipline, Bachelors preferred. Equivalent experience may be substituted for degree.


Knowledge:

  • Must have knowledge of managed care products, health insurance benefits, ICD 9, CPT codes and medical terminology. Must be familiar with managed care operations, including claims, customer service, provider relations, enrollment, COB, care management, behavioral health and customer expectations.

Skills:

  • Strong analytical and detail-oriented skills to organize/assess information; Problem solving skills to make recommendations based on data or authoritative resources; Ability to work independently; Ability to assess situations and respond appropriately by requesting training, documentation changes, and/or policy changes; Ability to effectively communicate, provide constructive feedback, and facilitate positive interdepartmental relationships; Ability to project a positive attitude and image by being professional, courteous, helpful and friendly in relationships with all levels of staff and management; Ability to work in multiple software applications and learn new applications quickly.


Work Experience:

  • Requires a minimum of two years’ experience in operations functions preferably in a managed care setting, Knowledge and experience in provider maintenance, credentialing, enrollment, COB, claims, customer service and/or provider relations preferred.

Johns Hopkins Health System and its affiliates are Equal Opportunity/Affirmative Action employers. All qualified applicants will receive consideration for employment without regard to race, color, religion, sexual orientation, gender identity,sex, age, national origin, disability, protected veteran status, and or any other status protected by federal, state, or local law.

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