​Serving tHE Healthcare,

Financial, Insurance, and Public SectorS

COMPLAINT INTAKE

Aridell Associates, LLC

Regulators expect organizations involved in healthcare delivery to patients enrolled in federal health insurance programs to have compliance programs capable of receiving, recording, tracking, and addressing complaints and allegations.  Compliance officers overseeing these programs must conduct a timely and well-documented reasonable inquiry into any compliance incident or issue involving potential program noncompliance or fraud, waste, and abuse. Noncompliance or fraud, waste, and abuse may be discovered through a hotline or complaint received by mail or electronic means.  Organizations need to have the proper mechanisms in place to properly address each one.

Lacking a system to handle complaints and allegations can lead to unwanted publicity, dissatisfied customers, loss of business, and increased oversight from regulators.  Others may have a system in place yet still encounter adverse events because of operational weaknesses.

Aridell possesses full-service call center expertise, including intake, prioritization, business risk, triage, trending, and tracking system services.  For instance, our subject matter experts are well-experienced in establishing complaint intake operations for healthcare plans and government program integrity operations.  This specific experience includes setting up a call center to handle the receipt of complaints and allegations, monitoring call center operations, developing and implementing tracking systems, triaging issues, implementing complaint scoring systems, conducting complaint linking analysis, researching complaints, and investigating complaints.


Aridell’s capabilities include:

  • Designing and Establishing Full-Service Complaint Intake Operations

  • Designing and Establishing Tracking Systems

  • Call Center Operations

  • Risk Assessment Tools

  • Complaint Triaging and Risk Scoring

  • Complaint Research and Investigation

  • Complaint Trending and Pattern Identification


 


 


 

Job Title: Sr. Project Manager/Lead (Full-Time)
Post Date: 5/26/2023 – 06/30/2023

Position Summary
Aridell Associates, LLC, a professional consulting firm, advises clients on healthcare program operations and helps clients develop solutions to maximize meaningful outcomes, improve their operations, and protect their valuable assets, as well as bestow customer confidence in their operations.  Our mission is to advance clients’ operational performance and provide sustainable long-term, successful business strategies.

If you are interested in providing consulting and advisory services or supporting contracts, then this project management level position is for you.  The Sr. Project Manager/Lead works as an integral member of a multi-disciplinary team in conducting program vulnerability activities in support of a contract. In this position, you will support the primary project manager in managing and leading program vulnerability projects, such as conducting research, identifying vulnerabilities, scoring risks, and reporting results. The Sr. Project Manager/Lead will receive all direction and instructions from a program manager or their designee for the work activities under the contract. 

Responsibilities

  • Under minimal supervision, interact with the client's various partners and stakeholders to discuss and address program fraud, waste, and abuse schemes; trends, patterns, and anomalies; and opportunities for improvement.
  • Contributes to improving operations and work flow efficiencies.
  • Responds to partners' and stakeholders' needs for information and clarification.
  • Uses positive interpersonal skills in conducting all work.
  • Develops and delivers presentations.
  • Prepares standard and ad hoc deliverables for clients.
  • Lead teams responsible for identifying, triaging, and prioritizing existing and emerging vulnerabilities in healthcare programs.
  • Provide guidance and support for vulnerability mitigation, and evaluate the success and impact of the mitigation strategies and completed actions in order to close vulnerabilities.
  • Promote the use of environmental scanning techniques to identify vulnerabilities.
  • Develop and prepare written risk assessments on different client programs and areas using standardized criteria.
  • Oversee the preparation of reports, including the findings and associated recommendations for submission to the client’s management.
  • Interact and confer with team members on a variety of topics, such as ideas, projects, approaches, methodologies, and strategies, using all forms of available communications.
  • Interpret complex healthcare and value-based payment programs' policies, laws, rules, regulations, manuals, and healthcare industry guidelines in conducting program vulnerability activities.
  • Serve as a technical resource in complex healthcare operations, data, and systems.


Qualifications

  • ​The position requires a bachelor’s degree with preference given to those degrees in a business, public policy, or public administration relevant field. 
  • At least five years of experience required in Marketplace, Medicare, Medicaid, and CHIP programs with an expert level of understanding of the regulations in the programs along with direct supervision of staff.
  • Experience working for a health plan or an oversight/regulatory government agency is preferred.​

 
Skills

  • Ability to work under pressure and short deadlines.
  • Requires professional presentation skills.
  • Strong organizational planning and prioritization skills with the ability to collaborate with others and multi-task.
  • Excellent written and verbal communication skills.
  • Ability to present to large or small groups when required.
  • Proficient in using the Microsoft Office Professional Suite, including Word, Excel, PowerPoint, and Outlook.


Travel Requirements
No travel is required. 

Job Location
This is a work-from-home/remote position.

Apply Now
Email Resume To: jarias@aridell.com​​​