Performance Support Specialist, Appeals and Grievances, New York, NY

Employer Healthfirst Inc.
Created 11/25/2021
Reference 1133187
Job type Full Time
State NY
City New York
The A&G Performance Support Specialist conducts supporting documentation needs analysis, works directly with A&G management to identify developmental areas, then creates and delivers training and other supporting documentation to develop staff. The Performance Support Specialist adheres to established learning objectives, in conjunction with the Enterprise Learning team, and selects and/or delivers instructional methodologies to facilitate learning and development. They are responsible for keeping internal training materials up to date and in alignment with department and corporate expectations, as well as develop any new materials based of regulatory, dept. or organizational needs. The Performance Support Specialist will work across functions and departments including coordination with Human Resources, Learning and Development, Regulatory, Appeals & Grievances, Operations, and Compliance to ensure that all materials, recommendations, etc. are complying.

Duties & Responsibilities:
  • Documents current state workflows and drafts future state workflows, incorporating regulatory requirements, quality, and efficiency within design.
  • Responsible for process definition, modeling, analysis and improvement across multiple operational areas.
  • Translate recorded working sessions, side chair observations and workgroup discussions into step-by-step documentation.
  • Influences the delivery and change management of systems through knowledge of existing business processes and future state system effect on processes.
  • Develops and maintains an inventory of business processes within department standards, in accordance with business decisions, technology changes and annual audits.
  • Provides process leadership to one or more business areas at all levels of the organization.
  • Analyzes processes for efficiency and effectiveness; provides solutions for minimizing complexity and waste, based on thorough analysis.
  • Responsible for appreciating and understanding end to end processes to ensure that sub optimization of the whole doesn't occur during process improvements in their area.
  • Assists with change management during process improvements.
  • Works with stakeholders and key staff across departments and at all levels to execute project plans.
  • Contributes to the development of A&G training curriculum.
  • Breaks down walls and finds the root cause of process inefficiency.
  • Standard operating procedure (SOP) auditing for unabridged process execution steps
  • Supplements and modifies SOP documentation based on audit trends and findings.
  • Manage approval cycles and business owner signoffs.
  • Develop process checklists.
  • Develop training/refresher training to include agendas, self-guided training, content knowledge exercises, formalized concept evaluations and individual performance assessments.
  • Partner with Learning and Development team to facilitate training in person and virtual new hire, refresher and skills enhancement training for appeals & grievances, based on business and audience needs.
  • Coordinate with corporate level Learning and Development team to deliver a comprehensive curriculum to the appeals & grievances team, including offshore resources, when and where needed.
  • Develop a delivery channel(s) plan that also considers confirmation of individual understanding. Summarize results and any next steps for leadership.
  • Manage and communicate regulatory or policy changes to team members.
  • Maintain a centralized repository of current and archived documentation and training material. Catalogue and organize material to allow for successful team access and use.
  • Act as a subject matter expert and assist with maintaining and updating all training materials, process documents, job aides and standard operating procedures. Engage as subject matter expert of the core system and any cross functional applications to support appeals & grievances.
  • Other duties as assigned.

Minimum Qualifications:
  • High School diploma or GED equivalent from an accredited institution.
  • Demonstrated knowledge in interpreting business process and standard operating procedures; developing procedural documentation, process maps; and leading/facilitating workshops, focus groups and discussions.
  • Experience facilitating learning and delivering material and presentations to multiple types of audiences.
  • Ability to master subject matter and become a product expert.
  • Ability to effectively communicate, in both written and oral form, with audiences at varying levels.
  • Proficient with Microsoft Office software applications (i.e. Word, PowerPoint, Excel, Outlook).
  • Ability to work independently.

Preferred Qualifications:
  • Bachelor's degree from an accredited institution, preferred focus study area in Healthcare Administration, or relatable field.
  • Demonstrated business process reengineering skills.
  • Ideal candidate will have a minimum of 3 years of experience within appeals & grievances and federal/state requirements surrounding appeals & grievances processing.
  • Experience interacting with health plan operational areas such as, claims, call center, utilization management, and care management.
  • Demonstrated knowledge of instructional design models, approaches andmethodologies.

Please note: Since we care so greatly about our employees' and members' wellbeing, Healthfirst is moving to an environment where our employees are fully vaccinated against COVID-19. As a prospective new team member, you must be fully vaccinated with a CDC/FDA approved COVID-19 shot(s) to work in our offices. If you are selected to interview for this role, we will explain our vaccination policy in further detail and ensure you are comfortable moving forward with this company policy.

WE ARE AN EQUAL OPPORTUNITY EMPLOYER. Applicants and employees are considered for positions and are evaluated without regard to race, color, religion, gender, gender identity, sexual orientation, national origin, age, genetic information, military or veteran status, marital status, mental or physical disability or any other protected Federal, State/Province or Local status unrelated to the performance of the work involved.

If you have a disability under the Americans with Disability Act or a similar law and want a reasonable accommodation to assist with your job search or application for employment, please contact us by sending an email to or calling 212-519-1798 . In your email please include a description of the accommodation you are requesting and a description of the position for which you are applying. Only reasonable accommodation requests related to applying for a position within Healthfirst Management Services will be reviewed at the e-mail address and phone number supplied. Thank you for considering a career with Healthfirst Management Services.

EEO Law Poster and Supplement

All hiring and recruitment at Healthfirst is transacted with a valid "" email address only or from a recruitment firm representing our Company. Any recruitment firm representing Healthfirst will readily provide you with the name and contact information of the recruiting professional representing the opportunity you are inquiring about. If you receive a communication from a sender whose domain is not, or not one of our recruitment partners, please be aware that those communications are not coming from or authorized by Healthfirst. Healthfirst will never ask you for money during the recruitment or onboarding process.

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