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Job Summary

The Operations Specialist is responsible for the daily operations of Geisinger Health Plan’s Children’s Health Insurance Program (CHIP) and Marketplace lines of business.

Job Duties

CHIP

• Track and manage incoming and outgoing Bureau of CHIP (BOC) inquiries; perform quality assurance reviews and ensure timely submission of BOC deliverables, including both ad hoc and routine reports.
• Identify, document, and assist in assigning appropriate business owners for new and revised CHIP regulatory requirements to ensure compliance and effective implementation.
• Provide support for the CHIP annual onsite audit, including coordination, documentation, and follow-up activities.
• Serve as a backup to the Benefits Specialist for State Government Programs, providing support for CHIP program operations as needed

Marketplace

• Review, validate, and implement updates to regulatory, operational, and compliance documents to ensure adherence to ACA guidelines, federal regulations, and submission deadlines.
• Collaborate with cross-functional teams to support Marketplace operations and implementation activities.
• Identify risks, gaps, and process improvement opportunities to enhance compliance and operational effectiveness.

Both CHIP and Marketplace

• Track and ensure timely, accurate submission of reports, filings, and required documentation across both lines of business.

Serves as an integral member of the team tasked with the oversight of Government Programs regulatory, compliance, legislative, sales and departmental operations. Assists with the development and maintenance of departmental policies and procedures, oversees routine and ad hoc regulatory responses, and supports the coordination and preparation of regulatory audits. Provides dedicated data and information technology expertise concurrent with the requirements of the department as they relate to applicable regulatory functions.

• Manages simultaneous projects that enhance the operation and efficiency of Department.
• Organizes, leads, and takes ownership of special projects and follows them through to completion.
• Coordinates and monitors the implementation of activities related to assigned projects and program requirements.
• Coordinates, corrects and supports rejected and pre-edits errors related to Encounter Data submissions for multiple lines of business.
• Oversees provider Attestations Responds to member appeals and grievances timely and with accuracy.
• Plans, coordinates and chairs ad hoc and related workgroup meetings with internal and external staff members as needed.
• Coordinates and supports regulatory audits.
• Assists in the preparation and distribution of necessary documentation to appropriate designees.
• Manages and tracks all incoming and outgoing documentation used in support of the audit.
• Coordinates, formats, organizes and uploads files for reporting and regulatory audits.
• Tracks and ensures timely and correct submission of reports in support of all lines of business.
• Remains open to regulatory and internal process changes and actively engages with other departments to implement changes to internal processes to avoid interruption with the revenue stream.
• Validates and implements changes identified within various documents to ensure compliance deadlines while adhering to all federal rules and regulations.

Work is typically performed in an office environment. Accountable for satisfying all job specific obligations and complying with all organization policies and procedures. The specific statements in this profile are not intended to be all-inclusive. They represent typical elements considered necessary to successfully perform the job.

Position Details

*Relevant experience may be a combination of related work experience and degree obtained (Associate’s Degree = 2 years; Bachelor’s Degree = 4 years).

Education

High School Diploma or Equivalent (GED)- (Required), Master's Degree- (Preferred)

Experience

Minimum of 5 years-Relevant experience* (Required)

Skills

Communication; Organizing; Working Independently; Computer Literacy; Waterfall Model

About Geisinger

Founded more than 100 years ago by Abigail Geisinger, the system now includes ten hospital campuses, a 550,000-member health plan, two research centers and the Geisinger Commonwealth School of Medicine. With nearly 24,000 employees and more than 1,700 employed physicians, Geisinger boosts its hometown economies in Pennsylvania by billions of dollars annually. Learn more at geisinger.org or connect with us on Facebook, Instagram, LinkedIn and Twitter.

Equal Opportunity Employer

All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, pregnancy, genetic information, disability, status as a protected veteran, or any other protected category under applicable federal, state, and local laws.

Our Vision & Values

Everything we do is about making better health easier for our patients, our members, our students, our Geisinger family and our communities.

KINDNESS: We strive to treat everyone as we would hope to be treated ourselves.

EXCELLENCE: We treasure colleagues who humbly strive for excellence.

LEARNING: We share our knowledge with the best and brightest to better prepare the caregivers for tomorrow.

INNOVATION: We constantly seek new and better ways to care for our patients, our members, our community, and the nation.

SAFETY: We provide a safe environment for our patients and members and the Geisinger family.

Our Benefits

We offer healthcare benefits for full time and part time positions from day one, including vision, dental and prescription coverage.