Job Description :

We are seeking a detail-oriented and proactive Provider Services Business Operations Analyst to assist the Provider Services Unit by maintaining productivity tools, supporting quality assurance processes, and participating in call campaigns and data cleanup initiatives, all while maintaining confidentiality and ensuring compliance with the Puerto Rico Medicaid Program (PRMP) and Center for Medicaid and Medicare Services (CMS) standards

Responsibilities:

• Assist with maintaining productivity tools for Enrollment & Maintenance Specialists, Field Representatives, and Provider Maintenance teams. 
• Support the upkeep of Quality Assurance (QA) tools and processes to ensure compliance and accuracy. 
• Responsible for supporting the provider services unit, including participating in and/or leading provider call campaigns. 
• Participate in data cleanup efforts to improve accuracy and integrity of provider related information. 
• Maintain documentation updates as assigned by leadership. 
• Collaborate with the Provider Enrollment Team to assist with productivity and QA report preparation (main analysis performed by leadership). 
• Assist with audit activities by preparing samples and verifying compliance (main reporting handled by leadership). 
• Maintain complete confidentiality in handling sensitive enrollment and maintenance issues related to the Puerto Rico Medicaid Program. 
• Ensure timely and accurate documentation and provide leadership status reports, as requested. 
• Being available to speak with team members when needed during work hours. 
• Complete reports provided by leadership by assigned deadlines. 
• Other duties as assigned by leadership.

Requirements:

• Bachelor’s Degree in Business Administration, Finance, Healthcare Management, Sciences, or a related field.
• Minimum of 2 years of experience or related training, including prior experience in the healthcare industry and knowledge of Medicaid programs, policies and procedures.
• Proficient in Microsoft Office (Word, Excel, PowerPoint, SharePoint). 
• Fully bilingual in English and Spanish. 
• Strong communication skills (written and verbal). 
• Ability to read and interpret policies, procedures, and technical documents.

EEOC