Operations Specialist - Government Programs, Health Plan (work from home Eastern Stan

Location:

Work from home (Pennsylvania)

Shift: Days (United States of America) Scheduled Weekly

Hours:

40 Worker Type:
Regular Exemption Status:
No

Job Summary:

The Operations Specialist is responsible for the daily operations of Geisinger Health Plan’s Children’s Health Insurance Program (CHIP) and Marketplace lines of business.

• CHIP Track and manage incoming and outgoing Bureau of CHIP (BOC) inquiries; perform quality assurance reviews and ensure timely submission of BOC deliverables, including both ad hoc and routine reports.
• Identify, document, and assist in assigning appropriate business owners for new and revised CHIP regulatory requirements to ensure compliance and effective implementation.
• Provide support for the CHIP annual onsite audit, including coordination, documentation, and follow-up activities.
• Serve as a backup to the Benefits Specialist for State Government Programs, providing support for CHIP program operations as needed.
• Marketplace Review, validate, and implement updates to regulatory, operational, and compliance documents to ensure adherence to ACA guidelines, federal regulations, and submission deadlines.
• Collaborate with cross-functional teams to support Marketplace operations and implementation activities.
• Identify risks, gaps, and process improvement opportunities to enhance compliance and operational effectiveness.
• Both CHIP and Marketplace Track and ensure timely, accurate submission of reports, filings, and required documentation across both lines of business.
• Serves as an integral member of the team tasked with the oversight of Government Programs regulatory, compliance, legislative, sales and departmental operations.
• Assists with the development and maintenance of departmental policies and procedures, oversees routine and ad hoc regulatory responses, and supports the coordination and preparation of regulatory audits.
• Provides dedicated data and information technology expertise concurrent with the requirements of the department as they relate to applicable regulatory functions.
• Manages simultaneous projects that enhance the operation and efficiency of Department.
• Organizes, leads, and takes ownership of special projects and follows them through to completion.
• Coordinates and monitors the implementation of activities related to assigned projects and program requirements.
• Coordinates, corrects and supports rejected and pre-edits errors related to Encounter Data submissions for multiple lines of business.
• Oversees provider Attestations.
• Responds to member appeals and grievances timely and with accuracy.
• Plans, coordinates and chairs ad hoc and related workgroup meetings with internal and external staff members as needed.
• Coordinates and supports regulatory audits.
• Assists in the preparation and distribution of necessary documentation to appropriate designees.
• Manages and tracks all incoming and outgoing documentation used in support of the audit.
• Coordinates, formats, organizes and uploads files for reporting and regulatory audits.
• Tracks and ensures timely and correct submission of reports in support of all lines of business.
• Remains open to regulatory and internal process changes and actively engages with other departments to implement changes to internal processes to avoid interruption with the revenue stream.
• Validates and implements changes identified within various documents to ensure compliance deadlines while adhering to all federal rules and regulations.
• Work is typically performed in an office environment.
• Accountable for satisfying all job specific obligations and complying with all organization policies and procedures.
• The specific statements in this profile are not intended to be all-inclusive. They represent typical elements considered necessary to successfully perform the job.

• Relevant experience may be a combination of related work experience and degree obtained (Associate’s Degree = 2 years; Bachelor’s Degree = 4 years).
• Education:
  
  High School Diploma or Equivalent (GED)- (Required), Master's Degree- (Preferred)
• Experience:
  
  Minimum of 5 years-Relevant experience (Required)
• Certification(s) and License(s):
• Skills:
  
  Communication, Computer…