Operational Excellence Specialist

CENTERLIGHT

. Conduct routine, targeted, and risk-based reviews of transactions, work queues, case records, and supporting documentation .

Posted 10/27/2026full-timeRemote • United StatesJunior💰 $55,000 - $65,000 per yearWebsite

Core Competencies

Role fit

Core Competencies

Use this summary to align your resume positioning with the role.

Demonstrates expertise in conducting quality reviews, analyzing compliance with healthcare regulations, and delivering effective training. Proficient in managing documentation and maintaining accuracy in case management processes.

Highest-signal resume keywords

Quality ReviewHealthcare ComplianceTraining DevelopmentElectronic Medical RecordsAttention to Detail

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Quality ReviewCase ManagementRoot-Cause AnalysisProcess MappingDocumentation ManagementCompliance GuidelinesCustomer ExperienceAppeals and GrievancesData AnalysisTraining Effectiveness Assessment

Soft Skills

Excellent Communication SkillsOrganizational SkillsFlexibilityIndependenceCollaboration

Tools & Technologies

Electronic Medical RecordsCase Tracking SystemsCustomer Relationship Management SystemsMicrosoft Office Suite

Certifications & Qualifications

Associate's Degree in BusinessHealth Care Certification

Industry Keywords

MedicareMedicaidCMS GuidelinesPACE OrganizationFrail or Elderly Population

About the role

Key responsibilities & impact

Conduct routine, targeted, and risk-based reviews of transactions, work queues, case records, and supporting documentation
Review assigned cases from intake through closure for accuracy, completeness, timeliness, routing, follow-up, workflow adherence, and applicable PACE requirements
Document findings, distinguish isolated errors from recurring process issues, coordinate corrections, maintain review logs, track remediation, and conduct follow-up reviews
Participate in calibration sessions to support consistent review standards
Review participant and authorized representative letters for SDRs, Appeals and Grievances before release when applicable
Verify notice elements, timeframes, language and accessibility needs, and delivery documentation using Compliance, NYDOH, and CMS-approved criteria
Escalate participant-rights concerns, overdue actions, privacy issues, and significant quality risks
Refer clinical judgments, service determinations, and legal or regulatory interpretations to authorized personnel
Develop and deliver onboarding, refresher, and process-change training and provide process-focused coaching
Develop and update training decks
Maintain approved procedures, job aids, checklists, letter-review guides, and training materials with process owners, including version control and distribution
Use identified cases and recurring findings in learning activities; track attendance and completion and assess training effectiveness
Analyze quality findings, repeat errors, rework, turnaround times, and bottlenecks; support root-cause analysis, process mapping, corrective action plans, and improvement tests
Report review volumes, error categories, recurring themes, remediation status, and improvement outcomes to leadership
Support audits and monitoring by organizing review evidence, training records, procedures, and corrective action documentation
Protect confidential information and follow privacy, security, and records-management policies

Requirements

What you’ll need

Associate's Degree in business, health care, or related field, or equivalent
Minimum of one (1) year of experience working with a frail or elderly population, or appropriate PACE organization or related industry training upon hiring if under one year and all other requirements are met
Experience in healthcare, Medicare & Medicaid, CMS guidelines, customer experience, quality review, and appeals and grievances
Experience using electronic medical records, case tracking systems, customer relationship management systems, or similar documentation platforms
Excellent written and verbal communication skills, including grammar, spelling, and punctuation
Ability to thrive in a fast-paced environment and meet assigned deadlines
Excellent organizational skills, accuracy, and attention to detail
Demonstrated ability to manage multiple projects and be flexible
Ability to operate independently and collaboratively
Proficiency in Microsoft Office suite, including Word, Excel, and Outlook
Fluent in English; bilingual preferred
Ability to meet stated physical requirements, including standing, sitting, lifting/pushing/pulling up to 50 pounds, bending/squatting, navigating stairs and walking, fine motor skills, visual reading and documentation, attentive listening and clear speech, and cognitive ability

Benefits

Comp & perks

Work from home
Reasonable accommodation for individuals with disabilities
Affirmative action and equal opportunity employment