HealthHelp - A WNS Company (www.HealthHelp.com), is the leader in the field of healthcare utilization & care management. We have gained this position by actively working to change out-of-date practices with a collaborative, non-denial based approach. Our methodology helps payors achieve a higher return on investment, gives providers education programs that better inform physicians, and ensures quality and safety for the patients needing treatment.
HealthHelp’s innovative approach and strong IT capability in specialty benefits management means that staff will move healthcare forward when provided with evidence-based solutions and second opinions. HealthHelp's staff is comprised of healthcare professionals who make a difference every day. HealthHelp has a desire to fill their company with talented and innovative people who want a career path filled with success and personal growth.
Our specialty benefits management services are broad and include, Cardiology, Oncology, Radiology, Radiation Therapy, Sleep Care, and Musculoskeletal Care. HealthHelp has two locations in Houston, one a corporate office and the second a state-of-the art contact center. HealthHelp is also proud to have another such contact center in Albany, New York.
WNS Global Services Inc. (NYSE: WNS) is a global Business Process Management (BPM) leader. WNS offers business value to 400+global clients by combining operational excellence with deep domain expertise in key industry verticals, including Banking and Financial Services, Consulting and Professional Services, Healthcare, Insurance, Manufacturing, Retail and Consumer Packaged Goods, Shipping and Logistics, Telecommunications, Travel and Utilities. Globally, the group’s over 44,000+ Professionals serve across 60 delivery centers in 16 countries worldwide.Job Description
Essential Duties and Responsibilities:
• Develops and supports implementation of new and updated operational workflows for Clinical Review related to new and existing health plan business, and operational readiness activities in support of new and revised products / programs, as well as upcoming compliance requirements
• Clearly and thoroughly documents new processes and process changes to ensure easy understanding and proper implementation, resulting in the appropriate desired outcomes
• Organizes, maintains, and provides, upon request, relevant workflow and process documentation
• Collaborates across all departments to develop operational process solutions to resolve quality and compliance problems/trends
• Works in conjunction with IT/Products departments to identify and implement improvements to current software programs and processes that affect effectiveness and efficiency of Clinical Review and Physician Review operations
• Compiles and reviews process and systems-related recommendations from users and integrates, as appropriate, into workflow improvement projects
• Reviews existing clinical review processes and workflows to identify opportunities for operational efficiencies and builds respective business cases for implementation, along with business requirement documentation for IT Department
• Participates in change management process to evaluate risk and impact of potential changes
• Performs data validation to ensure accuracy and appropriateness of operational activities
• Maintains the Turn Around Time grid, collaborating with Client Service and Compliance Departments to ensure accurate TAT information is captured, as well as working closely with Business Analysists and IT, checking for system functions/rules related to timeliness accuracy, driving change as needed
• Consult Physician Tier performance coaching regarding operations per client, program and HH policies, timeliness, compliance, and availability
• Gathers feedback from Clinical Review and Consult Physician Tiers for process and system enhancement opportunities, and identifies system solutions to increase effectiveness and efficiency
• Supports and assists the universities and Consult Physicians Reviewers with process-related inquiries, routing assistance, system issues, general questions, and other needs
• Participates in the HH Quality Management Program as required
• Adheres to all HIPAA, state, and federal regulations pertaining to the clinical programs
• Adheres to both URAC & NCQA standards pertinent to job description
• Provides quality customer service through all interactions with both internal and external customers
• Other duties as assigned to meet business needsQualifications
• Graduate of an accredited school of nursing with a current active, unrestricted LVN or RN license, required
• 1 year of clinical experience, required
• Bachelor’s Degree in a related field, preferred
• 1 year of experience in a managed care environment, preferred
• Technical writing and documentation skills, preferred
• Proficiency with Microsoft Office tools (MS Word, Excel, PowerPoint, and Visio) necessary to document, track, and present information related to programs/products supported
• Ability to work in a fast-paced, evolving environment
• Attention to detail and maintaining high quality standards is a must
• Ability to prioritize and manage concurrent projects and work independently with minimal supervision
• Quantitative, analytical, problem solving, organizational, communication, and interpersonal skills
• Interpret operational data and/or processes
• Experience proposing and implementing process changes resulting in measureable efficiency gain
This job operates in a professional office environment. This role routinely uses standard office equipment such as computers, phones, photocopiers, filing cabinets and fax machines.
The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. While performing the duties of this job, the employee is regularly required to talk and hear. The employee frequently is required to stand; walk; use hands to finger, handle or feel; and reach with hands and arms.
As business needs dictate
Please note this job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee for this job. Duties, responsibilities and activities may change at any time with or without notice.
HealthHelp provides equal employment opportunities (EEO) to all employees and applicants for employment without regard to race, color, religion, gender, sexual orientation, gender identity or expression, national origin, age, disability, genetic information, marital status, amnesty, or status as a covered veteran in accordance with applicable federal, state and local laws.Additional Information
All your information will be kept confidential according to EEO guidelines.
- Attention To Detail
- Audio Equipments
- Business Requirements
- Change Management
- Clinical Works