GENERAL SUMMARY:

To provide leadership, guidance, and supervision to the staff of the assigned Provider Operations Support Team. To organize, coordinate, and ensure that Team, Division, and Corporate standards are adhered to. Support and administer corporate policies, procedures, and philosophies to promote quality and consistency, and control of expense objectives.

PRINCIPAL DUTIES AND RESPONSIBILITIES:

• Provide overall direction and immediate supervision to the assigned staff of the Provider Operations Support Team through delegation of work assignments, projects, and tasks required to satisfy divisional and corporate goals, objectives, and strategies.
• Provide courteous, professional, consistent, and timely feedback to assigned Team members and Leadership in accordance with supervisory guidelines, with respect to direct reports. Ensure Team member performance by initiating appropriate coaching, mentoring, recommending staff training, and implementing corrective action within area of responsibility. Promotes an atmosphere that encourages and fosters superior teamwork and strong work ethics. Supports Provider Operations leadership and performs management duties when necessary.
• Establish and monitor activities, which will facilitate productivity, efficiency and customer service during the completion of system related projects. Ensure that the team establishes and maintains contact with all assigned customers regarding workload and priorities.
• Oversee and participate in business user acceptance testing within Provider Operations. Create, approve and execute test conditions that meet the requirements for the system testing initiatives. Analyze and review online, hard copy and automated files to determine accuracy and completeness to ensure end results are consistent and have conformed to required HAP and regulatory standards.
• Design, document and update complex business models related to the Provider Operations Division activities. Monitor processes quarterly to ensure the financial and procedural content is accurate and up to date. Participate in development of departmental policies and procedures related to activities of Provider Operations. Analyze operating procedures, recommend forward thinking solutions, generate ideas for continuous improvement and implement approved changes. Responsible for the accuracy and clarity of all documents. Ability to be thorough and complete when working, processing, or providing information and documenting. Ability to track details and create accurate documentation even under pressure.
• Conduct routine quality audits to measure and report claim processing, payment, and financial accuracy for Provider Operations Support Team. Ensure that audits are completed timely and outcomes are reported to direct leadership. Identify and report all developmental opportunities to Claims direct leadership for coaching and potential training on a monthly basis.
• Set a positive example for the team by modeling all core company values, policies and guidelines. Design, develop and conduct various training classes for both specialized and general topics pertaining to the claims cycle, including but not limited to claim processes, system navigation, and quality control efforts.
• Perform other related duties as assigned.