1+ months

Manager, Healthcare Billing Recovery Operations Programs

Sunrise, FL 33351
Regular Full Time
   

Responsibilities:
The Manager of Healthcare Billing Recovery Operations Programs plays a key role in the continuity across operational functions for applicable client program(s) aimed at optimizing operational efficiency, effectiveness, and overall service delivery to clients. 

Leverage your expertise in Medical Billing Recovery, knowledge of Coordination of Benefits (COB) and Third-Party Liability (TPL), Medicare Secondary Payer (MSP) claims involving Group Health Plan (GHP) and Non-Group Health Plan (NGHP), coupled with breadth of operational knowledge, adaptable skillset, experience leading teams and programs in operations and/or support functions to make a positive impact in the optimization of operational activity in a diverse, fast-paced business environment.

Responsible for operational training, including training related elements arising from and related to QA, Outreach, CMMI, SOPs and tools (operational policies/procedures/workflow), client requirements, etc. Provides leadership for functions and/or key initiatives in one or more operations/operations-related functions (listed above); collaborates with peers and program leaders for continuous improvement and progressive approaches to strategies and infrastructure for MSP operations .  May serve as a named resource and/or practice lead for specific business segment or operations specialty/support function on an ongoing or interim basis as may be needed. 

Essential Duties:

General and Management
Effectively collaborates and partners with other client program operational management and internal resources to ensure company compliance with departmental, company, regulatory (including but not limited to HIPAA and state/federal requirements), and client requirements and SLAs, and optimize service delivery.
Applies knowledge, skills, and abilities in one or more areas to developing and employing practices, tools and resources that contribute to meeting and exceeding client requirements.
Maintains in-depth knowledge and remain up to date with ongoing and sometimes rapid changes to client and regulatory requirements, as well as internal changes for all operational elements related to the client program and remain cognizant of ongoing and sometimes rapid changes.
Builds, manages and developments effective teams, which may be composed of leads, first level supervisors, professionals and agent staff members that are both exempt and non-exempt.  
Ensure resources for assigned areas are staffed appropriately scalable to operational demands.
Ensure team is accountable for following company policies, procedures, and requirements, as well as managing staff in accordance with management requirements, work volume, and budgetary requirement.
Provides feedback, coaching, and training to assigned team(s) to correct deficiencies and develop skills to increase capability and effectiveness of team members.
Builds HCS value and credibility internally and externally, and represents the organization in meetings with the client, provider organizations, contractors, subcontractors, and vendors as required.
Leverages excellent communication skills in order to influence a wide range of internal and external audiences.
Works on issues where analysis of situations or data requires an in-depth knowledge of client needs, organizational objectives, as well as an understanding of company operating policies and procedures.  
Inspires trust and credibility- delivers on commitments
May be required to work some Performant holidays due to client requirement.
Telework or work from assigned office as may be required based upon business needs in adherence with Company policies and requirements. 
Upon hire (and process facilitated by the Company through the client) obtain and maintain required government client clearances.

Training
Employs methods, tools, and fosters relationships that optimize the connectivity and continuity of program operations and support functions/areas (Operations, QA, Outreach, CMMI, shared services, etc.) that contribute to optimization of staff and program effectiveness. 
Manages new hire and ongoing operations training program and training staff for client program. 
Identify needs, develop and/or revise training content, materials and/or process documents to ensure accuracy and alignment based upon changing client requirements, periodic refreshers, performance improvement/QA results correction, new or modified SOPs, procedures, internal business needs and/or continuous improvement. 
Develops/deploys training plans, tools, delivery, and assessment methods that maximize professional learning success and lends to continuous improvement of staff and programs aligned with inputs and outputs of CMMS, QA and Outreach activity and trends (individual, team and departmental), and operational oversight.
Responsible for maintenance and enhancement of CMMI Operational Tactical Training plan as well as deployment, and continuous improvement activities. 
&bullectly manages newly hired caseworkers during their initial training and introductory period until they are released to assigned operational teams. 
Reviews divisional, focus group, team, and employee level operational inputs from follow-up interview/audits of employees, reports and statistics, and on-the-floor observations to identify trends of activity that may benefit from additional training, modifications to training, or process, procedure or policy improvement opportunity with the objective of maximizing efficiency, quality and overall operational results. 
Advises management of operational knowledge/training gaps, staff development issues, and other observations and areas of opportunity that may involve operations training.  Partners with management and HR on training and other action plans to address needs and opportunities.

Operational Tools and Programs  
May perform additional duties to serve as interim Quality Officer for MSP operations in the absence of the applicable management if necessary. Such period(s) of designation and scope of duties, if applicable, would be specified.  
Contributes to, leads, and/or drives initiatives as assigned and/or supported by Program Director in areas of evaluating, creating, or modifying SOPs, operational policies and other operational tools and resources, CMMI, Quality Assurance, Outreach, and other Operational programs and functions.
Leverages evaluation of client contract SOWs, SLAs and operational activities/functions and results to contribute to identification and implementation of continuous improvement and change management activities across operational functions for the program(s). 
Presents analysis and recommendations to applicable Healthcare Recovery Program and Operational management/leadership.
Contribute to development or enhancement of operational procedures, policies and tools, KPIs, metrics and/or methods used to measure performance of operations (GHP, NGHP, Payment Processing, CPNs etc.) and ancillary functions (QA, Outreach, and other program functions) and collaborates effectively across the program management and teams for best solution, implementation and change management process. 
Play key role in process for obtaining and maintaining quality certifications such as CMMI, as well as applicable internal or external audit activities for such certifications. Owns CMMI Tactical Operational Plan and execution thereof. 
Leads and drives various projects, programs and initiatives as assigned by management. 

Other
Perform other incidentals and related duties as required and assigned.

 


Required Skills and Knowledge:
To perform this job successfully, an individual must be able to perform each essential function satisfactorily. Below are representative of the knowledge, skills, and abilities required:

Depth and breadth of industry and operational knowledge and experience with medical claim research, analysis, auditing, billing procedures, recovery, medical terminology and medical coding; preferably in a role with responsibility for developing and enhancing tools and resources used to measure, evaluate, audit, train, and develop staff performing the same involving Coordination of Benefits (COB) and Medicare Secondary Payer (MSP) involving Group Health Plan (GHP) and Non-Group Health Plan (NGHP) Third Parties, including proven expertise in gathering and interpreting Explanation of Benefits (EOB) to answer questions and resolve complex medical billing issues, including Medicare and Medicaid claims.
Demonstrated ability to leverage operational data and diverse inputs of varying sources to identify areas and develop action plans for improvement of infrastructure and programs to optimize operational results.
Demonstrated skills and success developing and managing resources, tools, and programs for operations to ensure high quality, productivity, and continuous improvement of service delivery for clients. 
Demonstrated success leading and collaborating on initiatives and programs to support best practices and continuous improvement of operational infrastructure (process, procedures, workflow, policies, assessment, reporting, tools, etc.) 
Working knowledge of the Capability Maturity Model Integration (CMMI) for services.- 
Working knowledge and demonstrated success employing Project Management methods and tools.
Proven experience in developing and managing high performing dynamic teams in operations and/or operations support functions. 
Strong professional verbal and written communication skills that is effective with internal and external audiences at all levels; Ability to establish and maintain effective work relationships internally and externally at all levels, and influence effectively.
Remarkable interpersonal skills that lends to positive interactions with staff, peers, leadership, and stakeholders; servant leadership attitude and demonstrated ability to resolve conflict in a professional manner.
Excellent presentation skills and ability to lead group activities and discussions that result in effective  knowledge transfer, development, and/or desired business outcome. 
Demonstrated ability to develop effective training materials and tools; break-down large volumes of information and sometimes complex concepts into smaller components and materials that contributes to effective knowledge transfer and skill development of operational staff. 
Strong critical thinking, analytical and problem-solving skills.
Demonstrated ability to use data-driven methods to identify root cause and resolve complex problems.
Self-motivated and thrives in a fast-paced office environment performing multiple tasks cohesively, with keen attention to detail.
Strong proficiency using standard office technology; computer, various applications and navigation of on-line tools and resources
Experience and skills leveraging training content development and/or training delivery applications and tools highly desired.
Ability to effectively perform deliver results; working independently as well as cooperatively with others to promote a positive team environment.
Possess a personality type that is ethical, friendly, hard-working, and proactive.
Ability to adapt quickly and transition effectively to changing circumstances, client requirements, assignments, and business needs; and consistently performs job responsibilities.
Ability to work full-time on-site and/or remote as needed to meet business needs. 
Completion of Teleworker Agreement upon hire, and adherence to the Agreement (and related policies and procedures) including, but not limited to: able to navigate computer and phone systems as a user to work remote independently using on-line resources, must have high-speed internet connectivity, appropriate workspace able to be compliant with HIPAA, safety & ergonomics, confidentiality, and dedicated work focus without distractions during work hours.

 

Physical Requirements:
Performs duties in a busy standard office environment with moderate noise level or may work remotely from home-office as may be required based upon business needs, in accordance with company policies & procedures.
Sits or stands at a desk during scheduled shift, reaching as needed to use office equipment.
Makes and returns calls using an office phone system.
Views a computer monitor, types on a keyboard and uses a mouse.
Reads and comprehends information in electronic (computer) or paper form (written/printed).
Types frequently, but not constantly, using a keyboard and mouse.
Occasionally lifts/carries/pushes/pulls up to 10 pounds.

 


Education and Experience:


High School diploma or GED required.
Bachelors Degree in Business, Management, Information Systems, Finance, Healthcare Administration, or related (or equivalent combination of education and experience)
Some college in medical terminology, billing, coding, or Medical Billing/Coding certification preferred.
Project Management experience; PM certification highly desirable. 
CMMI experience; CMMI Professional certification highly desirable. 
Quality or Training certification, a plus.
Minimum 8 years of relevant progressive industry experience, preferably in one or more operational and/or operational support functions (operations training, QA, outreach, PMO, etc.) in medical billing reclamation or recovery.
Minimum 2 years of relevant experience in supervisory, management or other position with oversight, escalation, and/or review responsibilities.
Incumbent qualifications/resume must be approved by client for interim Quality Officer designation.

 

Other Requirements:
Must submit to and pass pre-hire background check, as well as additional checks throughout employment
Must be able to pass a criminal background check; must not have any felony convictions or specific misdemeanors.
Must submit to and pass drug screen.
Performant is a government contractor. Certain client assignments for this position requires submission to and successful outcome of additional background and/or clearances throughout employment with the Company.

 

Visa sponsorship is not available.

Job Profile is subject to change at any time.

EEO 
Performant Financial Corporation is an Equal Opportunity Employer. 
Performant Financial Corporation is committed to creating a diverse environment and is proud to be an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, national origin, ancestry, age, religion, gender, gender identity, sexual orientation, pregnancy, age, physical or mental disability, genetic characteristics, medical condition, marital status, citizenship status, military service status, political belief status, or any other consideration made unlawful by law. 

NO AGENCY SUBMISSIONS WITHOUT PERFORMANT AUTHORIZED AGENCY AGREEMENT AND APPROVED PERFORMANT JOB ORDER

 


   


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Categories

Posted: 2020-06-19 Expires: 2020-09-12
Analytics, audit, and recovery services for healthcare, government and student loans.

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Manager, Healthcare Billing Recovery Operations Programs

Performant Financial
Sunrise, FL 33351

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