En Triple-S, estamos comprometidos con brindar experiencias laborales significativas para nuestra Gente Valiosa. Nos esforzamos por la excelencia en todo lo que hacemos, desde la forma en que trabajamos juntos hasta la forma en que servimos a nuestros clientes.
Al unirte a Triple-S, serás pieza clave para nuestros esfuerzos de brindar atención médica accesible y de alta calidad, así como también contribuirás a nuestro propósito de habilitar vidas saludables. Servimos a más de a más de 1 millón de asegurados en Puerto Rico, a través de nuestras líneas de negocios Medicare Advantage, Medicaid, Comercial, Vida y Propiedad & Contingencia.
Construyamos comunidades saludables juntos. ¡Únete a nosotros!
JOB SUMMARY
ESSENTIAL FUNCTIONS
- Develop and implement strategies to ensure accuracy of risk adjustment payments.
- Align providers with revenue management strategy. In coordination with providers department, establish the plans and activities to ensure compliance.
- Responsible for identifying, managing and implementing strategic initiatives to accurately reflect risk adjustment revenue, and minimize risk.
- Develop resolution and plan for action for identified raps and EDPS discrepancies.
- Monitor and oversight vendor performance and contract. Manages, measures and evaluates vendor performance on an ongoing basis.
- Participates and Assess vendor alternatives. Establish performance metrics for review and evaluation.
- Represent the organization in dealing with vendors for the risk adjustment program.
- Oversee the implementation of data management controls to ensure data quality and integrity, developing tracking, validation and reporting tools.
- Oversee risk adjustment data validation audits by government agencies or outside audit vendors, providing assistance to internal stakeholders and conduct medical record chart reviews to validate diagnoses.
- Perform claims and medical record reviews with focus on accuracy of diagnoses, as needed to respond to particular issues, as part of regulatory audit, or as element of oversight audit.
- Participates in the implementation of tactical plans, follows up on assigned tasks, projects, or objectives to ensure that expectations are met.
- Prepare production reports, statistics and presentations when required.
- Assist in special projects and / or initiatives of the corporation.
- Provide recommendations to achieve the Division’s and Company’s goals.
- Hires, trains, coaches, counsels, motivates and evaluates the performance of direct reports. Establishes disciplinary actions when necessary and promotes employee performance recognition when applicable.
- Responsible for preparing, assigning tasks, monitoring workflow and day-to-day execution and employee activities.
EDUCATION
- Bachelor's Degree in Administracion de Empresas
Bachelor’s Degree in Business Administration with a major in Accounting or Finance with three (3) to five (5) years of experience in an Accounting or Finance area, preferably in insurance and health industry.
LICENSES AND CERTIFICATIONS
- No requerido
COMPETENCIES
- Dominio Financiero y del Negocio
- Analisis de datos
- Deleite del cliente
- Mentalidad una Compañía
- Desarrollo de talento
- Conocimiento Práctico en Tecnología
Es política de la compañía buscar a los(las) solicitantes calificados(as) para puestos en toda la empresa sin distinción de raza, color, origen nacional, religión, sexo, identidad de género, orientación sexual real o percibida, estado civil, condición social, las ideologías políticas, edad, discapacidad física o mental, condición de veterano o cualquier otra característica protegida por la ley.
Empresa libre de drogas. Patrono con Igualdad de Oportunidad de Empleo”. Acción Afirmativa para Veteranos y Personas con Discapacidad". Patrono con E-Verify para verificar la elegibilidad de empleo de todos los/las nuevos(as) empleados(as).
Invitamos a las mujeres, veteranos y discapacitados a participar.