Manager of Provider Services

Location: Madison, WI
Date Posted: 08-31-2018
CareNational
Manager of Provider Services – Health Plan
Madison, WI

Manager of Provider Services Job Summary:
  • Manage the activities of Business Analysts and Supervisor, Provider Services who are experts in claims processing software, provider database application, and/or other software related to claim reimbursement by:
    • Selecting, developing, motivating, training and retaining competent staff
    • Providing opportunities for professional development
    • Rewarding and recognizing accomplishments and successes
    • Establishing and reviewing individual and company goals to ensure alignment with the corporate mission and strategic and tactical plans
    • Ensure an appropriate distribution of the workload amongst staff members to allow timely completion
  • Serve on integrated work groups. Communicate policies and procedures to staff
  • Monitor staff that defines system needs to meet business requirements and assess problems related to complex business requests which require adaptive and/or corrective programming changes
  • Ensure staff performs validation and testing of complex development and/or build work to ensure adequacy, or determine need for reformulation
  • Review and approve all test plans to ensure requirements are fully tested and integration testing is conducted when applicable with other internal/external systems
  • Provide guidance and direction for Supervisor, Provider Services to appropriately delegate & carry out departmental projects successfully
  • Develop and guide mid- and senior-level business analysts through various project assignments.
  • Review project plans, attend meetings, participate in design sessions with staff when needed and approve test plans and report out to Project Manager on departmental progress or concerns
  • Mitigate resource concerns with staff on project and collaborate with external vendors, as necessary
 
Manager of Provider Services Background:
 
  • Bachelor’s Degree in Healthcare Administration, Business, Leadership, or related field.
  • 5+ years of experience in a combination of areas including claims processing, enrollment, analysis, fees, EDI, provider records and benefit plans.
  • 2+ years of team lead or supervisory experience preferred.
  • Hold Certification in Epic’s Tapestry tracks, including Tapestry Core and Benefits Engine Track or AP Claims and Contracts, and possibly EDI tracks
  • Maintain expert knowledge of at least 4 of the following business processes:
    • HL-EDI; HL-Enrollment; HL-Premium Billing; HL-Claims; HL-Referrals; HL-CRM; HL-Benefits; HL-Vendor Contracts; HL-Reporting Workbench; HL-Batch Jobs; CES; PlanLink; MyChart; OCR/OnBase; API Invoice/EOB process; Disaster Recovery/Business Continuity; Provider Database; ID Card Database; Infertility Database; McKesson Care Manager; Benefits Connection
  • Basic computer proficiency (MS Office and Healthcare IT Systems) and typing skills are necessary.
  • Understanding of operational reports, financial budgeting processes, and health care payment models.
  • Excellent verbal and written communication skills, as well as exceptional critical thinking skills.
  • Strong oral and written communication skills; ability to interact with internal and external contacts.
  • Possess planning, organizing, conflict resolution, negotiating and interpersonal skills.
 
#ADMIN
 
RON AMODIO
STRATEGIC DIRECTOR
CareNational
ron@carenational.com
480.269.9491 (CALL – TEXT – FAX)
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