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Job Description

Supports operational improvement projects within Third-Party Liability and throughout the organization including non-clinical areas to accomplish measurable business process improvements. Analyzes and measures the effectiveness of existing processes and helps to develop sustainable, repeatable and quantifiable clinical and business process improvements. Collects and analyzes process and quality data to initiate, develop, and recommend operational practices and procedures that focus on enhanced safety, increased productivity, and reduced cost. May focus on either quality or process improvement.

Flex-Virtual workplace category: Working Virtually is available with occasional on-site needs in Grand Rapids, MI.

Essential Functions

• Reporting & Data Analysis

• Responsible for generating/requesting, analyzing, and ensuring timely delivery of department, vendor, and any reports related but not limited to Financials – savings, forecasts, cost‐benefit analysis, etc.

• Operations ‐ receipts, processed, inventory, aging, processing times, benchmarks, etc.

• Compliance – SOM, CMS, External/Internal Audits

• Vendor Quality/Performance Oversight

• Assist in defining KPIs, SLAs, and any vendor performance metrics.

• Defines and constructs routine reporting that monitors/measures vendor KPI, SLA, performance, and contract terms adherence.

• Establishes effective communication channels with our vendors to ensure that a healthy, productive, and beneficial relationship is ongoing.

• Coordinates monthly, quarterly, yearly business review meetings with vendors and ensures substantive and relevant agenda topics are discussed.

• Provides business requirements to the Business Reporting, OnBase Development, and Advanced Analytics Teams for the design, development, and implementation of solutions that benefit both the TPL Department and its initiatives.

• Responsible for leading business members in keeping updated process maps for the TPL Team and Subrogation Program and assists in efforts to document policies & procedures, job aides, supports cycle time studies as needed, and any other initiatives geared towards improving the overall health and performance of the department.

• Supports improvement activities with advanced project plans outlining measurable deliverables and milestones.

• Supports the operational leadership to ensure that services are provided in accordance with State and Federal regulations, organizational policies and procedures, medical staff bylaws and accreditation/compliance requirements.

• Assists with development of appropriate indicators and measures of performance including tools and strategies for ongoing performance measurement.

• Utilize the electronic health record functionality to proactively identify quality improvement opportunities. Facilitates the development of clinical decision support resources.

• Familiar with best practice guidelines related to their assigned specialty and improvement teams.

• Develops concurrent data collection, analysis, dashboard/visual management and reporting tools for feedback to teams/departments, utilizing operational processes for improvement. Identifies common cause from special cause variation and conducts rapid cycle improvement.

• Educates teams on improvement strategies, methods, tools and safety behaviors.

• Drives continuous assessment and improvements the processes within the business and assists stakeholders and process owners in prioritizing improvement opportunities.

• Associate's Degree preferably in a health or business related degree or equivalent required

• Bachelor's Degree preferably in a health or business related degree preferred

• 2 years of relevant experience Health plan operations experience to include end to end claims operations and processes.

• Experience with root cause analysis Required

• Process improvement, workflow improvements, project management, change management, and / or creating efficiencies through experience Preferred

• Experience in a revenue cycle department preferred

• Microsoft Office Experience preferred

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Spectrum Health requires all team members to receive the COVID-19 vaccinations subject to certain exclusions based on the team member’s job category. Spectrum Health is committed to granting reasonable accommodations in accordance with applicable laws.

Accommodation Notice: If you are a qualified individual with a disability, you may request a reasonable accommodation in Spectrum Health's application process. Contact us at 616-486-SHHR (7447).

Spectrum Health grants equal employment opportunity to all qualified persons without regard to race, color, national origin, sex, disability, age, religion, genetic information, marital status, height, weight, sexual orientation, veteran status, or any other legally protected

category. See more here.