Location: Idlewild Ave, Tampa, FL 33634
Department: Operations - Configuration
Reports to: Manager, Configuration
Position provides direct management of exempt and non-exempt associates responsible for accurate and timely maintenance of provider network, related automated pricing methodologies, daily workflow of team, and configuration liaison between the Market and Shared Services.
- Oversees systematic processing of provider files sent from external vendors as well as those created internally through Batch processes.
- Maintains technical understanding of price rules, fee schedules, and provider contract loads, assures staff is trained and up to date on these.
- Manages and monitors key performance metrics and implements improvement plans either with an individual or at an aggregate level.
- Handles all direct employee personnel issues and processes (where applicable), including performance management, appraisal processes, development planning, and career pathing.
- Performs root cause analysis on global issues that affect downstream processes, including automated claims payments and Provider Directories.
- Supervises direct reports by assigning workload, monitoring quality and associate coaching.
- Serves as liaison between departments when it becomes necessary due to member or workflow issues.
- Develops, recommends, and implements process improvements to improve efficiencies and services provided.
- Oversees training associates on new processes and refresher training.
- Facilitate and participate in meetings with other departments and line of business as needed.
- Act in a liaison capacity for the Mgr/ Sr Mgr representing operations with other areas and business units.
- Demonstrates desired behaviors by exceeding others expectations and leads by example
- Completes gap analysis on training for the business.
- Other duties as assigned.
- Required: High School or GED
- Preferred: Bachelor's Degree in a related field
- Required:4 years of experience in Provider Network Development, Fee Schedules, High Volume Automated Claims Processes
- Required: Experience leading others on complex automated projects
- Demonstrated analytical skills
- Demonstrated written communication skills
- Demonstrated interpersonal/verbal communication skills
- Ability to communicate and make recommendations to upper management
- Technical understanding of automated claims processing, fee schedules, provider network structures, provider reimbursement methodologies. Understanding of contract terms and how they are loaded into the system.
- In-Depth knowledge of Health Insurance
- Strong understanding of managed care and its place in the health care industry
- Microsoft Word
- Microsoft Outlook
- Microsoft Excel
- Proficiency with all WellCare based systems utilized in job functions.