This position manages a team of supervisors (and possibly associates) within assigned unit in Operations. Manages payer, provider and patient complaint resolution. Monitors overall performance and productivity of the unit and ensures supervisors take appropriate action to ensure department goals and metrics are met including, but not limited to regular scheduled and just-in-time coaching, recommending re-training, performance management and mentoring associates. Consistently identifies areas of opportunity/process improvement within department and recommends and implements solutions as necessary.
• Works with department supervisors to ensure metrics are met. (TAT & PG’s)
• Supports management in driving strategic direction at the supervisor and staff level.
• Support supervisors on escalated calls, 3rd point of contact.
• Manages payer, provider and patient complaint resolution.
• Works with supervisors and staff employees to drive efficient call volume activity and management.
• Work with supervisors to create efficient work plans and daily assignments.
• Supports cross-functional process improvement efforts.
• Keeps abreast of technological and industry developments
• Processing of all direct reports timecards and ensuring all associates are completed.
• Creation and sign off of all Oscar requests.
• Reward and recognize associates monthly for performance above and beyond expectations.
• Create audits for external customers and report on findings.
• Perform interviews for new hires and tracking for all requisitions.
• Reviews and adheres to all Company policies and procedures and the Employee Handbook.
• Other duties as assigned.
• Responsible for signing off on all sales adjustments.
• Develop and administer operational policy.
• Participates in bimonthly calibration calls for Ulysses.
• Daily reporting on patient related cases.
• Daily patient cases updates.
• Corporate, Human Resource, and or provider related communications to supervisor.
• Performance management of staff
• Corrective action plans written when applicable.
• Process and client production improvement plans
• Support on individual budgets.
This position requires excellent communication (verbal and written), customer service and analytical skills as well as the ability to interact with all levels of management and a highly diverse population. Must have strong organizational and interpersonal skills and be able to effectively manage and prioritize multiple tasks, and demonstrate independent thought and critical thinking skills. Must be detail oriented, be responsive, problem-solve difficult situations with internal and external customers and with process and/or systems issues. Must convey a strong professional image, exhibit interest and a positive attitude toward the work and the company and demonstrate leadership qualities at all times.
To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill and/or ability required. Reasonable accommodation may be made to enable individuals with disabilities to perform the essential functions.
• Abides by and demonstrates the company Mission – Vision – Values through both behavior and job performance on a day-to-day basis.
• Convey a strong professional image, exhibit interest and positive attitude toward all assigned work.
• Adheres to and participates in Company’s mandatory HIPAA privacy program / practices and Business Ethics and Compliance programs / practices.
• Must be able to remain in a stationary position 90% of the time.
• Occasionally move about the office to access file cabinets, office machinery, etc.
• Constantly operates a computer and other office productivity machinery (i.e., a calculator, copy machine, and computer printer).
• Frequently communicates via phone and email. Must be able to exchange accurate information in these situations.
• Occasionally lift items weighing up to 10 pounds.
Bachelor’s Degree or the equivalent plus a minimum of two years of experience in supervising/managing others required. A minimum of 3 years of experience in operations, preferably in the medical, insurance or healthcare field is also required. Thorough knowledge of healthcare delivery/managed care regulations, contract terms/stipulations, capitation requirements and accepted home health standards of practice required. Knowledge of Excel, Word and Outlook is also required.
CareCentrix maintains a drug-free workplace in accordance with Florida’s Drug Free Workplace Law.