Quality Systems Specialist needed for Managed Care Organization

Under the overall direction of the Senior Manger of Provider Relations Operations, the Quality System Specialist has overall responsibilities for training, auditing and facilitating Continual Process Improvement in the Data Center.  The Quality Specialist will work with management staff to develop a comprehensive audit process and conduct auditing as prescribed.  She/he will also assist in training all data center staff.

 Specific Duties and Responsibilities

? Assists management in facilitating, coordinating and delivering training programs for new and existing data center staff

? Assists management in developing, maintaining all documentation including workflow, policies and procedures, and training materials

? Audits all data entries and report results to management

? Documents staff performance against standards

? Assists in the ongoing evaluation of policies and procedures, and the development and implementation of new performance standards

? Assists department with staffing deficiencies, as required, by providing temporary assistance

? Interprets complex provider contracts, policy and procedures to facilitate provider set-up in systems

? Supports ITS in testing to implement system upgrades and new systems

? Function as Subject Matter Expert in Facets and Cactus

? Other activities and duties as assigned by the Provider Relations Management Required SkillsMust be self-motivated and able to work independentlyMust be able to work with people at all levels within the organization and facilitate work group processesDemonstrated proficiency in all other provider systemsMust have knowledge of product benefits, provider contractsMust have knowledge of medical terminology, fee reimbursement, and claims processingMust know Microsoft Word for Windows and must have good spreadsheet application skills. Must be able to navigate in a multi-system environmentExperience with database management programs is a plusDetailed OrientedExcellent documentation skills

 Required Education and ExperienceB.A. or B.S. degreeOne year experience in a managed care organization required, preferably in Provider Services