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8 Business Systems Specialist jobs match your search criteria.

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Job Description: Enrollment Specialist Enrollment Specialist Location: New York, NY Salary:  Experience: 0.0 year(s) Job Type: Temporary / Consulting Job ID: U1009515       About the Opportunity An established nonprofit healthcare organization headquartered in New York City is actively seeking a driven and dynamic individual for a promising opportunity on their staff as an Enrollment Specialist. In this role, the Enrollment Specialist will be responsible for maintaining the integrity of the membership database for the Medicare line of business. Additionally, the Specialist will be responsible for reviewing all membership changes prior to entry into the database as well as processing files and making corrections prior to the submission of membership/enrollment data. Company Description Nonprofit Healthcare Organization Job Description The Enrollment Specialist: Ensures timely submission of enrollments to Centers for Medicare and Medicaid Services (CMS) Generates and sends required member correspondence during processing of enrollment and disenrollment requests Updates member records with changes relating to their enrollment Maintains a working knowledge of CMS regulations as they relate to the members enrollment in the plan Guarantees all required membership materials are sent within the required timeframes Analyzes and summarizes monthly reports to identify current trends of enrollments and dis-enrollments Develops strategies to address trends and ensure the continued growth of the program Develops a working knowledge and understanding of out of area tracking, all low income subsidy processes, late enrollment penalty appeals and retroactive processing procedures Creates a new member file to hold application and all documents concerning the member's enrollment Date stamps all withdrawal, cancellation, and disenrollment requests Required Skills High school degree or equivalent required or an equivalent combination of education and related work experience Demonstrated knowledge and/or experience with Medicaid/Medicare rules and regulations Experience with CMS and HRA Operating Systems Excellent verbal and written communication skills Basic computer knowledge including Microsoft (Word, Excel, Access and Outlook) Ability to work effectively in a team environment Ability to communicate effectively in front of small groups and in one-on-one discussions Desired Skills College Degree

Job Description: Billing Specialist Billing Specialist Location: Fairfield County, CT Salary: $15-$18 per hour Experience: 2.0 year(s) Job Type: Temporary / Consulting Job ID: U1005124       About the Opportunity A respected hospital located in Fairfield County, CT is actively seeking a highly organized and diligent individual for a promising opportunity on their staff as a Billing Specialist. As a Billing Specialist, the qualified candidate will pre-register patient demographic and insurance information in the hospital's billing system. This is an excellent opportunity for a qualified professional to advance their career with a recognized hospital located in Connecticut. Company Description Hospital Job Description The Billing Specialist will: Post charges for all modalities Assist the department reconciling each day's business Collect all patient paperwork Verify all required data was collected and entered correctly into ADS Ensure timely turnover of data Ensure that a report was generated for all exams Provide support to the patient financial services department Assist quality control department with any collection, preparation, and reconciliation processes Ensure data entry accuracy and efficiency are achieved Required Skills 2+ years of experience as a Medical Biller Polished and professional demeanor Ability to multitask Proficiency with computer platforms and applications Detail-oriented Highly organized Strong interpersonal skills Excellent communication skills

Job Description: Quality Information Specialist Quality Information Specialist Location: Jacksonville, FL Salary:  Experience: 2.0 year(s) Job Type: Temporary / Consulting Job ID: U1014668       About the Opportunity An established managed care organization located in Jacksonville, FL is actively seeking a compassionate and driven healthcare professional for a promising opportunity on their staff as a Quality Information Specialist. In this role, the Quality Information Specialist establishes and fosters a healthy working relationship between large physician practices, IPAs and the organization. For the right candidate, this role has the potential to transition into a full-time opportunity. Apply today! Company Description Managed Care Organization Job Description The Quality Information Specialist (RN): Advises and educates large Provider practices and IPAs in appropriate HEDIS measures, medical record documentation guidelines and HEDIS ICD-9/10 CPT coding in accordance with NCQA requirements Collects, summarizes and trends provider performance data to identify and strategize opportunities for provider improvement Collaborates with Provider Relations to improve provider performance in areas of Quality, Risk Adjustment and Operations (claims and encounters) Delivers provider specific metrics and coach providers on gap closing opportunities Identifies specific practice needs where the organization can provide support Develops, enhances and maintains provider clinical relationship across product lines Leads and/or supports collaborative business partnerships, elicit client understanding and insight to advise and make recommendations Partners with physicians/physician staff to find ways to explore new ways to encourage member clinical participation in wellness and education Provides resources and educational opportunities to provider and staff Captures concerns and issues in action plans as agreed upon by provider Required Skills Bachelor's Degree in Nursing or equivalent work experience of 3+ years directly related HEDIS record collection with analytical review/evaluation and / or Quality Improvement; or 2+ years of experience in directly related HEDIS medical record review and/or Quality Improvement with experience in data and chart reviews to provide consultation and education to providers and provider staff 1+ year of experience in Managed Care experience One of the following: LPN, RN, APRN Proficient in Microsoft Office programs Proficient in Generic Healthcare Management Systems Ability to identify basic problems and procedural irregularities, collect data, establish facts, and draw valid conclusions Demonstrated interpersonal/verbal communication skills Knowledge of medical terminology and/or experience with CPT and ICD-9 coding Ability to multitask Desired Skills Master's Degree in Nursing One fo the following: HCQM, CHP, CPHQ

Job Description: Quality Information Specialist Quality Information Specialist Location: Fort Myers, FL Salary:  Experience: 2.0 year(s) Job Type: Temporary / Consulting Job ID: U1014671       About the Opportunity An established managed care organization located in Fort Myers, FL is actively seeking a compassionate and driven healthcare professional for a promising opportunity on their staff as a Quality Information Specialist. In this role, the Quality Information Specialist establishes and fosters a healthy working relationship between large physician practices, IPAs and the organization. For the right candidate, this role has the potential to transition into a full-time opportunity. Apply today! Company Description Managed Care Organization Job Description The Quality Information Specialist (RN): Advises and educates large Provider practices and IPAs in appropriate HEDIS measures, medical record documentation guidelines and HEDIS ICD-9/10 CPT coding in accordance with NCQA requirements Collects, summarizes and trends provider performance data to identify and strategize opportunities for provider improvement Collaborates with Provider Relations to improve provider performance in areas of Quality, Risk Adjustment and Operations (claims and encounters) Delivers provider specific metrics and coach providers on gap closing opportunities Identifies specific practice needs where the organization can provide support Develops, enhances and maintains provider clinical relationship across product lines Leads and/or supports collaborative business partnerships, elicit client understanding and insight to advise and make recommendations Partners with physicians/physician staff to find ways to explore new ways to encourage member clinical participation in wellness and education Provides resources and educational opportunities to provider and staff Captures concerns and issues in action plans as agreed upon by provider Required Skills Bachelor's Degree in Nursing or equivalent work experience of 3+ years directly related HEDIS record collection with analytical review/evaluation and / or Quality Improvement; or 2+ years of experience in directly related HEDIS medical record review and/or Quality Improvement with experience in data and chart reviews to provide consultation and education to providers and provider staff 1+ year of experience in Managed Care experience One of the following: LPN, RN, APRN Proficient in Microsoft Office programs Proficient in Generic Healthcare Management Systems Ability to identify basic problems and procedural irregularities, collect data, establish facts, and draw valid conclusions Demonstrated interpersonal/verbal communication skills Knowledge of medical terminology and/or experience with CPT and ICD-9 coding Ability to multitask Desired Skills Master's Degree in Nursing One fo the following: HCQM, CHP, CPHQ

Job Description: Family Nurse Practitioner (FNP) Family Nurse Practitioner (FNP) Location: Long Island, NY Salary: $95,000-$105,000 Experience: 5.0 year(s) Job Type: Full-Time Job ID: J129930       About the Opportunity A premier health center headquartered on Long Island is actively seeking a licensed healthcare individual for a promising opportunity on their staff as a Family Nurse Practitioner (FNP). This is an excellent opportunity for a compassionate and patient-oriented healthcare professional to join one of Long Island's most recognized health systems. Company Description Health Center Job Description The Family Nurse Practitioner (FNP) will perform Family Practice duties in a busy primary care setting. The FNP will work 35 hours per week, five days a week. Required Skills New York State Family Nurse Practitioner license 5+ years of experience within primary care as an NP Bilingual, English and Spanish MSN Patient-oriented Excellent ambulatory skills Compassionate and empathetic Excellent communication skills

Job Description: Quality Practice Advisor (HEDIS) Quality Practice Advisor (HEDIS) Location: Newark, NJ Salary:  Experience: 2.0 year(s) Job Type: Temporary / Consulting Job ID: U1011592       About the Opportunity A recognized healthcare organization located in Newark is actively seeking a diligent and driven healthcare professional, with a strong HEDIS background, for a promising opportunity on their staff as a Quality Practice Advisor. In this role, the Quality Practice Advisor establishes and fosters a healthy working relationship between large physician practices, IPAs and the organization. Company Description Healthcare Organization Job Description The Quality Practice Advisor: Collects, summarizes and trends provider performance data to identify and strategize opportunities for provider improvement Collaborates with Provider Relations to improve provider performance in areas of Quality, Risk Adjustment and Operations (claims and encounters) Delivers provider specific metrics and coach providers on gap closing opportunities Identifies specific practice needs where the organization can provide support Develops, enhances and maintains provider clinical relationship across product lines Leads and/or supports collaborative business partnerships Partners with physicians/physician staff to find ways to explore new ways to encourage member clinical participation in wellness and education. Provides resources and educational opportunities to provider and staff Captures concerns and issues in action plans as agreed upon by provider   Required Skills BSN or equivalent work experience of 3+ years directly related HEDIS record collection with analytical review/evaluation and / or Quality Improvement 2+ years of experience in directly related HEDIS medical record review and/or Quality Improvement with experience in data and chart reviews to provide consultation and education to providers and provider staff 1+ year of experience in Managed Care experience One of the following: LPN, RN, APRN Proficient ion Healthcare Management Systems Intermediate knowledge of Microsoft Office Suite Demonstrated analytical skills (Intermediate) Demonstrated customer service skills (Intermediate) Ability to analyze information and covert related activities into a comprehensive work plan Desired Skills MSN HCQM, CHP, or CPHQ

Job Description: Quote Associate Quote Associate Location: Hartford County, CT Salary: $14-$17 per hour Experience: 1.0 year(s) Job Type: Temporary / Consulting Job ID: U1008532       About the Opportunity A financial services company in Connecticut is looking to fill an immediate need with the addition of a new Quote Associate to their staff. Working with a growing team to ensure consistency, accuracy and efficiency for all setting up and generation of quotes for clients, the Quote Associate will be responsible for evaluating and pricing new business for Life, Dental, Short Term Disability and Long Term Disability products for a specific group of clients. Company Description Financial Services Company Job Description The Quote Associate will: Build and maintain effective working relationship with assigned inside sales specialists, employee benefits representatives and broker Ensure there is effective support to inside sales by acting as a full team member and providing critical support as needed to all phases of the sales process Input customer logistics to enable generation of the quote Identify and obtain missing information material for assessment and/or pricing of the risk Verify customer information within the system to ensure accuracy Required Skills 1+ year of related work experience High School Diploma Microsoft Office/Suite proficient (Excel, etc.) Customer service oriented Solid analytical and problem solving skills Great interpersonal skills Excellent communication skills (written and verbal) Strong attention to detail Highly organized Able to multitask efficiently and effectively Desired Skills Bachelor's Degree in a related field Sales or Insurance industry experience Knowledge of Insurance products and systems

Job Description: Quality Practice Advisor Quality Practice Advisor Location: Jacksonville, FL Salary:  Experience: 2.0 year(s) Job Type: Temporary / Consulting Job ID: U1011417       About the Opportunity A widely recognized managed care organization headquartered in Jacksonville, FL is actively seeking a self-motivated and compassionate healthcare professional fro a promising opportunity on their staff as a Quality Practice Advisor. In this role, the Quality Practice Advisor educates providers and supports provider practice sites in regards to the National Committee for Quality Assurance (NCQA) HEDIS measures. Company Description Managed Care Organization Job Description The Quality Practice Advisor (RN): Collects, summarizes and trends provider performance data to identify and strategize opportunities for provider improvement Collaborates with Provider Relations to improve provider performance in areas of Quality, Risk Adjustment and Operations Delivers provider specific metrics and coach providers on gap closing opportunities Identifies specific practice needs where the organization can provide support Develops, enhances and maintains provider clinical relationship across product lines Defines gaps in the organization's service relationship with providers and facilitate resolution Leads and/or supports collaborative business partnerships Partners with physicians/physician staff to find ways to explore new ways to encourage member clinical participation in wellness and education Provides resources and educational opportunities to provider and staff Captures concerns and issues in action plans as agreed upon by provider Required Skills Bachelor's Degree in Nursing or equivalent work experience of 3 + years directly related HEDIS record collection with analytical review/evaluation and / or Quality Improvement 2+ years of experience in directly related HEDIS medical record review and/or Quality Improvement with experience in data and chart reviews to provide consultation and education to providers and provider staff 1+ year of experience in Managed Care experience One of the following licenses:  Licensed Practical Nurse, Registered Nurse (RN), Acute Care Nurse Practitioner (APRN) Demonstrated interpersonal/verbal communication skills Knowledge of medical terminology and/or experience with CPT and ICD-9 coding Ability to implement process improvements Knowledge of healthcare delivery Proficient in Microsoft Office programs and Healthcare Management Systems Desired Skills Master's Degree in Nursing

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Business systems specialists are part of the IT team that works on developing and supporting the company’s applications.

Because business systems specialists develop business applications, they need a thorough understanding of their company’s business needs. Together with business staff members, business systems specialists identify technology needs and improve workflows.

Although business systems specialist jobs involve a component of designing, programming and implementing unique applications, they also assist in the implementation of third party vendor systems. Other duties include analyzing and improving systems, researching technology trends and troubleshooting problems.

To qualify for business systems specialist jobs, candidates need a bachelor’s degree in information technology, computer science, computer engineering or a related field. Good analytical and communication skills are necessary to succeed in these positions.

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