The CSI Companies is actively seeking a Retention Specialist for a contract role with our client in Poughkeepsie, New York. This a great chance to join the team of a company that was recently awarded one of Fortune 2018 World’s Most Admired Companies!
Our client is seeking candidates that can interview and get started immediately. All candidates must complete and pass a Background check, drug screening, and other health screenings if required.
Because The CSI Companies is a cut above the typical staffing firm, we understand that an attractive benefits package is an important aspect of recruiting above-average W-2 contractors to serve our clients. Our benefits package includes weekly pay, direct deposit availability, multiple healthcare plans to include vision, dental, disability options, 401K and holiday and paid time off.
The Retention Specialist is a critical member of Operations Quality Management Team and works closely with the Operational areas in Tampa to identify real time abrasion/disenrollment potentials. The Operational Retention team will identify areas of process breakdown and potential disenrollment to help build provider and member retention strategies based on detailed data analysis on Claims, Customer/Provider Service, and Enrollment.
- Analyze reports Claims denial, front-end rejects. denials reason codes to determine appropriateness and areas of intervention.
- Determine report specifications for ad-hoc reports needed for key abrasion/retention efforts and summarize accordingly.
- Analyze daily call contact reports to determine accuracy. follow up. time frames and possible disenrollment threats.
- Contact Members at risk for disenrollment based on report analysis and act as an elevated resolution team.
- Identify additional areas of clarification needed for members and providers based on call contact reports and claims reporting.
- Communicate findings to Operations. Marketing. Quality etc. to facilitate the creation of needed job aides. areas of training. member material updates. newsletter updates. etc.
- Monitor analyze and report information from Results (outsource vendor) for disenrollment survey information.
- Communicate with the Operations Manager weekly regarding key areas of member and provider abrasion for tracking and trending.
- Analyze grievance report data to determine trends. updated training needs. adherence to State reporting guidelines. and communications.
- Work with the Operations Manager on the Maintenance of Sharepoint communication documents. banner messages. automatic email updates. and compliance alerts.
- Monitor Ohio NOA process reports as well as Right to State Hearing documentation to identify appropriateness of that decision.
- An Associate's Degree in a related field Required
- A Bachelor's Degree in a related field Preferred
- 3+ years of experience in managed care or health plan focusing on claims processing. reimbursement methodologies and charge systems Required
- 2+ years of experience in data analysis/financial analysis with healthcare data Preferred
- Government programs experience (Medicare and Medicaid) Preferred
- Demonstrated analytical skills
- Demonstrated project management skills
- Demonstrated interpersonal/verbal communication skills
- Demonstrated written communication skills
- Ability to multi-task
- Technical writing skills Advanced
- Ability to summarize large amounts of information into intelligent
- Microsoft Project Intermediate Required
- Microsoft Access Intermediate Required
- Microsoft PowerPoint Intermediate Required
- Microsoft Excel Intermediate Required
- Familiarity with reporting tools (Crystal. Discovery. etc.)
- Experience with HSD Diamond managed care system