Become a part of our caring community and help us put health first
 

The Senior Process Improvement Professional, DSNP Encounters Data Management supports the Encounter Data Management team within the Healthcare Quality Reporting and Improvement organization (HQRI).
The Senior Process Improvement Professional analyzes, and measures the effectiveness of existing business processes and develops sustainable, repeatable and quantifiable business process improvements.
The Senior Process Improvement Professional work assignments involve moderately complex to complex issues where the analysis of situations or data requires an in-depth evaluation of variable factors.

The Senior Process Improvement Professional will partner with multiple teams and leaders to execute existing and new state implementations to include solving for business issues and/or opportunities related to monitoring DSNP encounter submissions and payments. They will be responsible for the creation of process flows and will write policy and procedure documents.  

You will partner closely with peers across the organization to enhance business processes while identifying opportunities, interpret data, produce recommendations and track plans to completion. Support communication efforts through summaries on status of multiple projects and reporting on trends and metrics.

This role exercises independent judgment and decision making on moderate issues regarding job duties and related tasks and works under minimal supervision. This role will develop and maintain partnerships with a diverse group of teams and develop trusted relationships as they work side by side to accomplish goals. The individual will also work on medium-scale projects and moderate complexity.

In this role, you will:

• Develop and maintain reporting mechanisms to track, trend and monitor success and results.
• Lead and influence project completion by fostering collaborative partnerships, identifying opportunities and solving challenges.
• Design end to end process flows inclusive of technical architecture to identify opportunities, hand offs, clarity roles and responsibilities, and controls and monitoring needed.
• Communicate and present effectively, listen actively, and attentively to others, build relationships.
• Own execution of daily operating objectives and goals, report outs, key performance metrics.
• Ability to manage multiple tasks, priorities, and deadlines with diligence.
• Ability to understand state and regulatory compliance.

Use your skills to make an impact
 

Required Qualifications

• Minimum 2 years of process improvement/implementation and/or project management experience.
• Detail oriented with excellent organizational and project management skills.
• Take ownership of process improvement projects and serve as a Subject Matter Expert on high-visibility initiatives.
• Demonstrates autonomy in managing tasks, proactively advancing projects, and appropriately escalating challenges.
• Builds and sustains a robust network of collaborative professional relationships.
• Communicates effectively in both written and verbal formats, fostering meaningful connections across teams and stakeholders.
• Translates complex concepts into clear, actionable insights tailored to diverse audiences.
• Applies analytical expertise to independently investigate intricate issues and uncover root causes.
• Navigates shifting priorities with ease, maintaining productivity across multiple tasks.
• Expert experience utilizing Microsoft applications such as Word, Excel, PowerPoint, and Lucid.

Preferred Qualifications

• Minimum 1 year of experience medical claims payment and processing in a medical claim’s environment
• Experience creating pivot tables and consumable information within Excel
• Knowledgeable in regulations governing health care industries or related adjacent industries

Additional Information

Work-At-Home Requirements:

• WAH requirements: Must have the ability to provide a high-speed DSL or cable modem for a home office. Associates or contractors who live and work from home in the state of California will be provided payment for their internet expense.
• A minimum standard speed for optimal performance of 25x10 (25mpbs download x 10mpbs upload) is required.  
• Satellite and Wireless Internet service is NOT allowed for this role.
• A dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information

Interview Format:

As part of our hiring process for this opportunity, we will be using an exciting interviewing technology called Hire