Manages the regional operations account management team specifically related to Provider contracting and payment issues both internally & externally. Creates and implements appropriate processes and monitors daily performances as it pertains to the production, quality, and service to ensure that company goals and departmental metrics are met. In connection with provider operations and regional staff, partners with director to design and implement processes to remediate identified root cause issues.
Department:Operations – National Account Management
Reports to:Sr Dir, National Account Management
Location: 949 Kamokila Blvd, 3rd Floor, Kapolei, HI 96707
- Directs a team of geographically distributed resources to improve operational performance in the market through metric based management.
- Establishes process between regions and corporate departments to identify, diagnose, and remediate provider operational issues (some states may also remediate member issues).
- Monitors goals and works closely with account managers to drive performance and to ensure provider satisfaction metrics are met or exceeded.
- Applies analytical tools and techniques to identify root causes, prevalence and impact of issues across multiple states/business units. Develops strategies to reduce problems and improve efficiency over time.
- Recruits, selects, trains and retains highly qualified professionals. Provides the leadership necessary to maintain a motivated, productive and competent team through open communication and delegation of responsibilities and authority.
- Tracks and trends root causes to develop systematic solution to operational challenges.
- Provides support to staff by answering questions and resolving technical issues.
- Manages oversight on issue resolution.
- Manage and oversee activities to ensure that services comply with governmental and accrediting agency regulations.
- Ensures the delivery of superior customer services by providing timely and accurate resolution to claims and credentialing related provider inquiries and complaints regarding inventory processing.
- Manages and develops direct reports who include other management or supervisory personnel and/or exempt individual contributors.
- Partners with director to set operational priorities and manages resources to operational goals and budgets.
- Identifies opportunities to improve department results, communications and operating efficiencies.
- Manages workload and assignments, measures performance and initiates personnel actions as necessary.
- Perform other duties as assigned.
- Required A Bachelor's Degree in a related field or equivalent work experience
- Required 7 years of experience in Managed care, preferrably operations management, claims processing/issue resolution or provider contracting environment
- Required 2 years of management experience Robust experience with operational process and root cause analysis
- Required Other Data and work process analysis and problem identification
- Preferred Other Medicare and/or Medicaid experience
- Advanced Demonstrated written communication skills
- Advanced Demonstrated interpersonal/verbal communication skills
- Advanced Knowledge of healthcare delivery
- Intermediate Ability to lead/manage others in a matrixed environment
- Intermediate Ability to influence internal and external constituents
- Intermediate Ability to work in a fast paced environment with changing priorities
- Intermediate Demonstrated leadership skills
- Intermediate Demonstrated analytical skills
- Intermediate Ability to implement process improvements
- Advanced Other Facilitative skills
- Advanced Other Quantitative analysis and financial modeling capabilities
- Required Intermediate Microsoft Access
- Required Intermediate Microsoft PowerPoint
- Required Intermediate Microsoft Outlook
- Required Intermediate Microsoft Excel
- Required Intermediate Microsoft Visio