Who we are:
Meridian Health Plan is a family-owned, family-operated company of passionate leaders, achievers, and innovators dedicated to making a difference in the lives of our members, our providers and in the healthcare industry.
We provide government-based health plans (Medicare, Medicaid, and the Health Insurance Marketplace) in five different states (Michigan, Illinois, Indiana, Kentucky, and Ohio).
Our employees work hard, play hard, and give back. Meridian employees enjoy: Happy hours, special events, company sports teams, potlucks, Bagel Fridays, weekly Executive Lunches, and volunteer opportunities.
A Day in the Life of a Clinical Operations Analyst:
The Clinical Operations Analyst works under the direction of the department Director and/or Manager of Clinical Operations. The Clinical Operations Analyst is responsible for coordinating with all internal and external stakeholders in providing varied, complex, operational and confidential detailed analysis in support of the Clinical Operations department. This position is responsible for effectively identifying and communicating, interdepartmentally, both issues and resolutions to said issues by effectively applying process-improvement and/or problem-solving techniques, while providing general operational support to the Clinical Operations team. This position also develops and communicates technical specifications that are necessary to meet regulatory and quality clinical data requirements. The Clinical Operations Analyst is responsible for applying both previously obtained and newly acquired knowledge to achieve desired outcomes, while generally providing analytical support and well-informed business decisions – consistent with current trends in the healthcare industry.
- Participate in and lead project planning initiatives, attend project-status meetings and successfully manage project timelines and implementations
- Gather, compile, model, and validate medical and pharmacy data utilizing company supported computer-based applications and tools
- Determine objectives and metrics that are both appropriate and measurable as it applies to evaluating the efficiency of projects and production outcomes, reporting, implementations and department key performance indicators
- Provide summary reports, cost analysis, member impact, etc. regularly and as needed based on business needs
- Develop, review, summarize and analyze department specific reports, committee material, and documents, make recommendations in collaboration with management as necessary
- Document and standardize both current and future-state department policies & procedures (P&P’s) utilizing various mediums, including but not limited to flow-chart mapping and written narratives
- Ensure annual review and updates of department policies & procedures
- Act as the department SharePoint administrator. This includes overseeing, maintaining and updating the content on the Clinical Operations SharePoint site
- Status projects, escalate issues and communicate to management as appropriate
- Recommend adjustments to established project and implementation timelines while accounting for new and/or unforeseen variables to ensure successful and timely completion of projects and program implementations
- Work with management to perform quality audit and KPI dashboard reporting, address and identify opportunities for improvement, and implement plans to mitigate risk
- Track department KPI and department goals weekly
- Review, analyze, and develop State reports requiring Clinical Operations data and work with key stake holders to ensure all departments are involved appropriately
- Prepare, gather, review, and analyze material for internal meetings including but not limited to; quarterly IRR, P&T committee, MHP UMC, and Clinical Operations involvement with companywide workgroup meetings
- Assist the Clinical Operations team with problem solving and goal identification and improving processes that promote effective drug therapy and enhance member outcomes. Identify and pursue opportunities to achieve operational efficiencies
- Extract data from MCS, MERLIN, Data Warehouse and other systems, perform appropriate verification of data, and format, print and distribute reports to internal and external stakeholders, including graphical representations of data/reports as needed
- Analyze all Pharmacy Benefits Manager (PBM) reports and develop tracking/trending where needed, as well as develop outlier thresholds, provide potential intervention and resolution, as well as report on other metrics as needed
- Perform gap analysis and provide feedback and recommendations to leadership team
- Ensure compliance with all company, state and federal rules and regulations. This includes investigating any prior authorizations and appeals that appear out of compliance.
- Maintain HIPAA standards and confidentiality of protected health information; consistently demonstrate compliance with HIPAA regulations, professional conduct and ethical practice
- Assist and support the team with data entry and outreach
- Perform other duties as assigned
What you can bring to Meridian:
- Bachelor’s degree or Fellow Designation from the Academy of Healthcare Management (“AHM”) or a minimum of 2 years’ experience in managed care is required
- Passing score on the Analyst Assessment is preferred
- Customer service experience or related health care industry experience is required
- Experience in a Managed Care and/or Pharmacy Benefit Manager (PBM) environment is preferred
- Teamwork experience is required
- Demonstrated adaptability and flexibility to changes and response to new ideas and approaches is required
- Knowledge of managed care and government programs is preferred
- Knowledge of the health insurance industry is preferred
- Knowledge of National Committee for Quality Assurance (NCQA), URAC and/or general accreditation standards is preferred
- Superior verbal and written communication skills
- Superior analytical and problem solving skills
- Superior computer skills
- Demonstrated willingness to work in a fast-paced, team-oriented environment while maintaining a constant focus on quality-improvement and opportunities to enhance member satisfaction
- Ability to demonstrate patience, courtesy and professionalism during every engagement with all internal and external stakeholders
- Ability to learn new skills and acquire knowledge in both the independent and team settings
- Ability to think critically, identify issues with current processes and propose solutions to identified issues
What Meridian can offer you:
- Our healthcare benefits include a variety of PPO plans that are effective on the first day of employment for our new full-time team members.
- Opportunity to work with the industry’s leading technologies and participate in unique projects, demonstrations, conferences, and exclusive learning opportunities.
- Meridian offers 401k matching that is above the national average.
- Full-time MHP employees are eligible for tuition reimbursement towards Bachelor’s or Master’s degrees.
- Meridian Health Plan was named Detroit's #1 Fastest Growing Company by Crain's Magazine, so it is a great time to get involved with Meridian.
Meridian is an equal opportunity employer (EEO)