Medical Management Business Specialist

    • Job Tracking ID: 512935-589822
    • Job Location: Meridian, ID
    • Job Level: Entry Level (less than 2 years)
    • Level of Education: BA/BS
    • Job Type: Full-Time/Regular
    • Date Updated: September 05, 2017
    • Years of Experience: Up to 2 Years
    • Starting Date: October 23, 2017
    • Salary Type:: Hourly
    • Rate:: 15.23
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Job Description:


Job Summary


The Business Specialist is responsible for driving projects and bringing value to operations through operational analysis, identification of performance trends, evaluating current processes and managing improvements, reviewing and processing monthly reporting, and managing current and future technology projects. This position works in partnership with all functional business units to achieve department strategic, tactical, and project goals.

Key Result Areas

  • Identifies process improvement needs within the Medical Management department.

  • Monitors and reports monthly Medical Management activities across the book of business.

  • Evaluates performance of AUM/Access program as it relates to existing and potential new business.


    Identifies potential improvements in the Medical Management workflow or supporting systems and collaborates with the TSC/IT team and supervisors to implement necessary changes

  • Facilitates problem solving sessions with functional leads and/or work teams within Medical Management and across the organization to accomplish common goals.


    Able to work with and create efficiencies/solutions in the AUM/AHH system and all other related documentation software(s) (MCG, MEDai, etc)


    Able to work with and troubleshoot the Avaya phone system


    Open and edit Medical event screens

  • Identify potential new members through MEDai Predictive Modeling,

  • Determine work flow for calls and letters of potential new members.

  • Assisting Supervisor and Nurses in a manner necessary to service clients

  • Document Processes

  • Develop and implement audit and control measures for assigned functional area.

  • Ensure inventory levels fall within company specific guidelines, including TAT and quality

  • Understand, analyze and improve metrics, processes and systems as related to Medical Management

  • Establishes appropriate system controls to ensure operational performance service levels are being met in accordance with established client expectations, cost, and budget expectations.

  • Provides data and thorough project recommendations to the Management Team to support strategic decision making

  • Other Related Duties as assigned or needed.

  • Identifies factors to gauge strategic and operational achievements related to efficiency enhancing projects and consequently communicates the achievements through internal and external means.

  • Provides input on department strategy, based on knowledge of industry and technology needs.

  • Develops a standard process for evaluation of the impact of operational changes.


Experience and Skills:


Minimum Qualifications

  • Bachelor’s degree in Business, Communication or Finance preferred

  • Experience of knowledge of health care industry preferred.

  • 1 - 2 years project management or UM/related field experience preferred.

  • Uses strategic thinking; ability to identify, distinguish and analyze multiple components of a problem, and make recommendations for business change.

  • Strong quantitative skills such as statistics and data analysis.

  • Business reporting and analytics including communication of needs as it relates to query based tools such as SQL.

  • Knowledge of medical terminology, ICD-9/10 and CPT coding principles, HIPAA

  • Basic knowledge of health insurance principles

  • Experience with all Microsoft products


    Reliability, Dependability, Punctuality, and Flexibility

  • Strong written and verbal communication skills.

  • Ability to work efficiently, perform multi-tasking, prioritize tasks, and meet tight deadlines

  • Ability to efficiently and effectively perform the Essential Key Result Areas with or without a reasonable accommodation without posing a direct safety threat to others or self

  • Protect and enhance the Core Purpose and the Core Values of the AmeriBen/IEC Group.