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IT-BPM - Associate III - BPM

Company: NR Consulting LLC
Location: Aliso Viejo
Posted on: June 22, 2022

Job Description:

Job Description: Proficiency: A Voice Associate: Able to independently take customer support calls effectively and efficiently ;follow the SOPs to complete the process and endeavour to resolve the issue, handle some escalated issues or escalate to a more knowledgeable person to resolve, in alignment with SLAs and assists Lead I BPM.
A Data Associate should independently be able to effectively and efficiently process the transactions assigned in timely manner, clarify complex transactions to others and ensure that quality of output and accuracy of information is maintained, in alignment with SLAs and assists Lead I BPM.
Expectations from this role:
Independently achieves the following; guiding other process associates and assists Lead 1 - BPM
1. Service Level Agreement (SLAs) specified by the client in terms of quality, productivity and schedule should be managed to ensure 100% adherence.
2. [Data]: Analyze information, enter and verify data, follow the SOP to ensure completion of the task. [Voice]: Customer calls, responses and any updates or edits to workflow based on after call work should be performed as per directions.
3. Address performance issues and improvement plans of team and self with supervisor.
4. Expected to be proficient in the process and domain to ensure quality of transactions and guide the same to the process associates.
5. Perform QA for production associates as an expert in the function and ensure completion within SLAs.
6. Create reports on performance metrics for team to manage productivity.
7. Understand the process and bring forward ideas and solutions to simplify and automate them to increase operational efficiency. Create automation solution and submit the same to Lead I for review.

Typical performance measures:
1. 100% Adherence to quality standards
2. Adherence to turnaround time for response and resolution
3. Completion of all mandatory training requirements
4. 100% adherence to process and standards
5. 100% adherence to SLAs where applicable
6. Number of issues fixed/tasks completed
7. Number of non-compliance issues with respect to SOP
8. Zero/No Client Escalations
9. Number of high-quality RCA and QA output
10. Daily/weekly performance reporting
11. Mentors A1 and A2 resources on the processes
Performance Areas:
Processing [Data]: Processing transactions assigned as per SOPs
Handling calls [Voice]: Handle customer support calls, resolve issues and complete after-call work

1. Production: Take calls (voice) or process complex transactions (data)
2. Issue Resolution:
" Address any problems with the supervisor/QA to ensure maximum productivity and efficiency.
" Identifies, analyses and solves the incidents/transactions.
3. Productivity:
" Proficient in the process, assisting other team members who are new to the process as well to ensure quick readiness of the team.
" Take steps to improve performance based on coaching.
" Production readiness of new joiners within agreed timeline by providing guidance Actively participate in the team's or organization wide initiatives
" Able to handle and manage higher complexity tasks.
4. Adherence:
" Be aware of any client s process or product updates and ensure 100% compliance towards the same.
" Adhere to release management process.
" Thorough understanding of organization and customer defined process. Consult with mentor when in doubt.
" Adherence to defined processes.
" Adhere to organization s policies and business conduct.
5. Reporting: Create reports on specific SLAs/performance measures/KPIs
6. Stakeholder Management: Guide the team in preparing status updates and keep management updated about the status.
7. Training:
" Attends one on one need-based domain/project/technical trainings as needed.
" On time completion of all mandatory training requirements of organization and customer.
" Provide on floor training and one to one mentorship for new joiners.
8. Escalation: Escalate problems to appropriate individuals/support team based on established guidelines and procedures.
9. Monitoring: Monitor progress of requests for support and ensures users and other interested parties are kept informed.
10. Manage knowledge: Consume project related documents, share point, libraries and client universities
11. Mentoring:
" Mentor and provide guidance to peers and junior associates.
" Assist new team members in understanding the customer environment.
12. Communication: Status update to the respective stakeholders and within the team
13. Collaboration:
" Collaborate with different towers of delivery for quick resolution (within SLA); document learning's for self-reference.
" Collaborate with other team members for timely resolution of errors.
Skill Examples:
1. Customer Focus: Focus on providing a prompt and efficient service to customers, goes out of the way to ensure that individual customer needs are met.
2. Attention to detail to ensure SOPs are followed and mistakes are not knowingly made
3. Team Work: Respect others and work well within the team.
4. Communication: Speak clearly and write in a clear and concise manner. Uses appropriate style and language for communication (Data)
5. Communication: Speaks in an accent neutral manner or with the accent required for the process, with good vocabulary and grammar skills. Writes clearly (Voice)
6. Typing Speed with 15WPM and 80% accuracy
7. Analytical approach: Makes systematic judgments based on information and relevant assumptions.
8. Ability to follow SOP documents and escalate the alerts within the defined SLA Willingness and ability to learn new skills, domain knowledge etc.
9. Make rule based and discretionary decisions.
10. Process Trainer/Sr. QA/Domain Expert/MIS Analyst
11. Frontline resource - Voice/Backoffice, Quality Auditors, SME, Domain Experts
Knowledge Examples:
1. Expertise with Windows Operating Systems, MS Office tools
2. English comprehension Reading, writing and speaking
3. Domain knowledge based on process (healthcare, banking, investment, F&A, retail, customer support, etc)
4. Familiarity with work allocation and intake functions
5. Familiarity with quality control processes including pare to analysis and root cause analysis
6. Knowledge on security policies and tools
7. Good understanding of customer infrastructure, ability to co-relate failures
8. Experience level 3 to 7 years
Comments for Suppliers:

The Auditor, DRG Coding & Clinical Validation position has an extensive background in nursing, inpatient coding and reimbursement guidelines and specifically has a solid understanding of the MS-DRG, AP-DRG and APR-DRG payment systems. This position is responsible for auditing client data and generating high quality recoverable claims for the benefit of Cotiviti and our clients. Responsible for performing clinical reviews of medical records and other documentation to evaluate issues of coding accuracy, medical necessity, and the appropriateness of treatment setting, and services delivered. Primarily responsible for auditing efforts by executing projects assigned by the Director, Audit Operations or Manager, Audit Operations. Displays professional skepticism that enhances the work performed to achieve success in position. Key Responsibilities:- " Identifies and Enters Claims. Integrates medical chart coding principles and objectivity in performance of medical audit activities. Draws on advanced ICD-9 and ICD-10 coding expertise and industry knowledge to substantiate conclusions. Performs work independently, reviews and interprets medical records and applies in-depth knowledge of coding principles to determine potential billing/coding issues, and quality concerns. " Effectively Utilizes Audit Tools. Utilizes with advanced proficiency, Cotiviti and client tools required to perform duties. Enters the claim into Cotiviti system accurately and in accordance with standard procedures. Updates current reports, develops and runs custom queries and validates accuracy of current reports used. Makes determinations based on prior knowledge, experience of client contract terms with the likelihood of recovery acceptance. " Meets or Exceeds Standards/Guidelines for Productivity. Maintains production goals and quality standards set by the audit for the auditing concept. Audits against the expected level of quality and quantity (i.e., hit rate # claims written, ID per hour). " Meets or Exceed Standards/Guidelines for Quality. Achieves the expected level of quality set by the audit for the auditing concept, for valid claim identification and documentation. " Prepares Responses to Client Disputes. Provides independent verification of claims validation, insurance, or employer validation in a concise written manner. " Reviews Provider Contracts. Demonstrates high level of expertise in researching requirements necessary to make recommendations on client contracts to fit projects within standard reports such as medical policies and state and federal statutes. " Identifies New Claim Types. Identifies potential claims outside of the concept where additional recoveries may be available. Suggests and develops high quality, high value concept and or process improvement, tools, etc. " Recommends New Concepts and Processes. Has broad in-depth knowledge of client, contract terms and complex claim types gained from extensive healthcare auditing experience. Suggests, develops, and implements new ideas, approaches and or technological improvements that will support and enhance audit production, communication and client satisfaction. Evaluate information and draw logical conclusions. Collaborates with Data Services in developing new reports. Education & Work Experience " Associates Degree or equivalent relevant experience required. Bachelor s degree in Nursing, Healthcare Economics, Health Information Management, and/or Business, preferred, or 5 - 7 years experience (experience in any of the following: claims auditing/quality assurance/recovery auditing - ideally in a DRG / Clinical Validation Audit setting or hospital environment) strongly preferred. " Strongly required Nursing education (ASN, BSN, or MSN); active, unrestricted license. " Three (3) years practical Clinical /Nursing experience in an inpatient setting is preferred. " Coding certification required and maintained as a condition of employment. (CCS, CIC, CPC, RHIA, RHIT, CCDS or CDIP

Keywords: NR Consulting LLC, Aliso Viejo , IT-BPM - Associate III - BPM, Accounting, Auditing , Aliso Viejo, California

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