Region: Columbia
JobID: 41514
 

Summary:

  • Develops, interprets, and implements policy and procedure changes for the area as a result of contract directives and/or internal audits. Assesses impact of area projects on operational processes and facilitates adjustments. Responsible for compliance with all applicable state and federal regulatory and accreditation requirements.

 

Primary Objectives:

  • Manages negotiation/interpretation of contract directives, ensuring problem resolution while providing expert communication to customers. Manages system testing/implementation projects to change internal policies/procedures affected by contractual requirements. Recommends updates to policy/procedural content on the website or as found in other customer communications such as scripts for customer service/call centers. Coordinates changes with other affected departments.
  • Oversees effective operation of a medical services area and/or risk management, ensuring customer satisfaction and operational efficiency. Supports medical services and/or risk management audits and recommends policy and procedural changes based on findings.
  • Researches the healthcare environment and develops recommendation for processing improvements as well as delivering effective, influential presentations for peers, directors, and senior management with the goal of increasing efficiency.
  • Participates in budget planning and determines business requirements to successfully meet project goals. Identifies items that impact scope, budget, risk, and resources of various work efforts and communicates with the area senior personnel and management on these items. Recommends adjustments, as necessary, including the impacts to project plans and/or resource requirements.
  • Develops programs to motivate and grow leadership skills among staff.

 

Requirements:

  • Bachelors Degree.
  • Five years of job-related experience in a healthcare, insurance or similarly complex operations environment.
  • Two years supervisory/lead experience OR two years of equivalent military experience in grade E4 of above.
  • Superior organizational and customer service skills.
  • Excellent verbal and written communication skills.
  • Strong project management and leadership skills.
  • General understanding of government/business. contracts/rules/regulations and overall operations.
  • Working knowledge of general auditing or quality assurance practices.
  • Advanced analytical, negotiation and presentation skills.

 

Preferred Work Experience:

  • Three or more years of experience of project management.
  • Two years of experience in a people management role.
  • Understanding of Medicare Claims Processing Guidelines.
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