* Position is eligible for Remote / Work from Home opportunity *

Department: Part A Medical Review

Telecommuting Eligible: Yes

Job Grade: N11

Notice of Collection & Privacy Policy for Applicants Residing in California: California Applicant Privacy Policy | Noridian (noridiansolutions.com)

Job Title

Clinical Services Operations Specialist

Job Summary

The Operations Specialist provides support services within departments and/or teams. The position conducts research, prepares, updates, and maintains electronic records using computer systems.

Essential Functions

Key Duties/Responsibilities/Accountabilities

• Accurately prepares and/or processes electronic records to and from workflows by verifying, entering, organizing, sorting, and routing to appropriate locations.
• Conducts research to resolve unique and complex errors or issues with records and/or systems.
• Communicates with others based on research findings.
• Provides guidance to others based on research findings.
• Monitors, tracks, and/or communicates workload status to appropriate staff.
• Creates and/or processes incoming and/or outgoing communication.
• Cross trains to multiple functions or workloads.
• Prioritizes functions or workloads depending on business need and/or direction.
• Collaborates and communicates with peers and leaders.
• May process live claims using applicable computer systems.
• May contact customers to obtain, clarify, or provide information through phone, email, fax, or other communication methods.
• May mentor and/or train peers and may assess review accuracy/quality of peers.
• May be assigned other special projects and/or assignments.

Non-Essential Duties and Functions

• Other duties as assigned

Minimum Qualifications

• High school diploma or GED
• 1 year clerical experience
• Experience working in multiple computer systems at one time
• Strong computer experience
• Microsoft Office experience
• Strong written and verbal communication skills

Preferred Qualifications

Above requirements and the following:

• 2 years’ clerical experience
• 1 year Noridian Healthcare Solutions experience
• Healthcare/healthcare administration experience
• Government or private insurance experience
• 10-key proficiency
• Strong research, analysis, and organizational skills
• Strong prioritization skills
• Strong problem-solving skills
• Strong attention to detail

Environment and Cognitive/Physical Demands

• Office Environment
• Ability to read, hear, speak, keyboard, reason, communicate effectively and problem solve
• Requires prolonged sitting and telephone use
• Requires the use of office equipment such as computer terminals, telephones, copiers and printers
• Infrequent lifting to 15ounds
• Infrequent stooping

Segregation of Duties

Every employee is responsible to perform their duties and responsibilities in accordance with Noridian values, policies and procedures, including but not limited to: Segregation of Duties Principles, HIPAA, Security and Privacy, CMS requirements, the Noridian Compliance Program and any other applicable laws, rules and regulations.

Statement of Other Duties

This document describes the essential functions, requirements, and responsibilities of this job, and is not intended to be a complete list of all tasks and functions. Employees may be requested to perform job related tasks other than those specifically listed in this description and may be required to perform any task requested by the supervisor or management.

Total Rewards Package:

Health, Dental and Vision Insurance, Voluntary Insurance Plans, Health Savings and Flexible Spending Accounts, 401k and Company Match, Company-paid Life Insurance, Education Assistance Program, Paid Sick Leave, Paid Holidays, Increasing PTO Accrual Plan, Medical/Parental/Disability Leave, Workers Compensation, Retiree Benefits, Severance Package, Employee Assistance Program, Financial and Health Wellness Benefits, Casual Dress, Open Office Setting, and Online Learning System.

CMS Access Compliance and Regulation Contingency Statement

Some positions require compliance with (i) federal and agency specific regulations and related clauses included in Noridian's prime contracts with the Government, (ii) background checks, and (iii) eligibility for a government-issued identification card.

Equal Employment Opportunity

Equal Opportunity Employer of Minorities, Females, Protected Veterans, and Individuals with Disabilities as well as Sexual Orientation or Gender Identity.

Below is the salary range for potential new hires.

Salary Range: $17.20 – $20.61

Other Compensation: Incentive Plan

Lifestyle Benefit: $50/month

This job will be closed 03/12/2024 at 8:00AM CST. No further applications will be considered.

Qualifications

Education

Preferred

High School

General Ed Diploma

Equal Opportunity Employer/Protected Veterans/Individuals with Disabilities

The contractor will not discharge or in any other manner discriminate against employees or applicants because they have inquired about, discussed, or disclosed their own pay or the pay of another employee or applicant. However, employees who have access to the compensation information of other employees or applicants as a part of their essential job functions cannot disclose the pay of other employees or applicants to individuals who do not otherwise have access to compensation information, unless the disclosure is (a) in response to a formal complaint or charge, (b) in furtherance of an investigation, proceeding, hearing, or action, including an investigation conducted by the employer, or (c) consistent with the contractor’s legal duty to furnish information. 41 CFR 60-1.35(c)