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Provider Relations-Networking-Contracting WellCare - PR & Contracting Management Careers

Provider Resolution - Senior Manager Job

Full Job Title: Sr. Manager, Provider Resolution

Job Number: 1705240

Locations:
Louisville, KY
Hazard, KY
Lexington, KY
Owensboro, KY
Ashland, KY
Bowling Green, KY

Date Posted: 11-7-2017

"PLEASE NOTE: THIS POSITION TO BE LOCATED IN ONE OF THE FOLLOWING LOCATIONS: LOUISVILLE, LEXINGTON, HAZARD, OWENSBORO, BOWLING GREEN OR ASHLAND, KY"

Incumbent plans, manages and directs activities for a team within Market Operations, responsible for internal and/or external payment issues, budgeting, workforce planning, process improvement and root cause analysis. Monitors daily performance as it pertains to production, quality and service to ensure company goals and departmental metrics are met.

REPORTS TO: SR. DIRECTOR, PRODUCT OPERATIONS

DEPARTMENT: KENTUCKY OPERATIONS-STATE

POSITION LOCATION: LOUISVILLE, LEXINGTON, HAZARD, OWENSBORO, BOWLING GREEN OR ASHLAND, KY


Essential Functions:

  • Develops and maintains claim project tracking to assure issue resolution, accuracy and completeness.
  • Works closely with Claim Operations and Configuration to develop permanent solutions to claims payment barriers and configuration issues.
  • Manages and develops direct reports. Directs work assignments, measures results and initiates personnel actions as required.
  • Supports companywide initiatives by managing detailed action plans, coordinating action steps with matrix partners, and driving resolution of issues.
  • Applies a comprehensive knowledge of claims and provider contracts to resolve Provider and claims payment issues.
  • Identifies process improvement initiatives to improve departmental results, communications and operating efficiencies.
  • Establishes objectives, goals and performance measures for the function being managed.
  • Ensures services and initiatives comply with governmental and regulatory requirements.
  • Makes recommendations on matters of policy and approve changes in area of expertise.
  • Other duties as assigned.
Candidate Education:
  • Bachelor's Degree in a related field or equivalent work experience is required
Candidate Experience:
  • 7 years of experience in healthcare, preferably in Claims and/or Customer Service is required
  • 3 years of experience in progressively responsible managerial work is required
Candidate Skills:
  • Demonstrated organizational skills
  • Demonstrated project management skills
  • Demonstrated leadership skills
  • Ability to lead/manage others
  • Demonstrated written communication skills
  • Demonstrated interpersonal/verbal communication skills
  • Other Knowledge of regulatory requirements concerning Medicare and Medicaid preferred
  • Ability to assess impact of change

Technical Skills:
  • Microsoft Word is required
  • Microsoft Excel is required
  • Microsoft PowerPoint is required
  • MS Project is required
  • Microsoft Outlook is required *LI-RG1

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Last Updated On: 12/9/2015