Posted in Other 30+ days ago.
The Manager of Group Health Implementation is a central role that interfaces with customers to handle a variety of pre and post-implementation functions. The position is an important link to ensure Group Health customer requirements are handled and met in an efficient and professional manner.
Excellent organizational skills are required, as an important part of the job will be developing timelines, coordinating tasks, and staying aware of all aspects of assigned projects. Communication skills need to be at a high level, as the role involves communicating with customers and One Call team members on a regular basis. Troubleshooting and problem resolution are required skills. The manager is responsible for monitoring program metrics to detect potential issues and recommend solutions, especially when issues threaten to negatively impact client expectations. Interpersonal skills are critical. The ability to establish and maintain effective working relationships with all levels of management (internally/externally), employees, clients and vendors, is fundamental to this role. The type of person that would embrace this position is friendly, professional, and secure in an ever-changing work environment that is typical in a customer service setting. Other attributes that the ideal candidate will encompass:
* A good understanding of One Call's diagnostic business
* Positive attitude to please customers
* Able to clearly articulate messages to a variety of audiences
* Able to establish and maintain strong relationships
* Time management in fast paced environment
* Organizational skills to maximize productivity
* Adapts to customer situation and different personalities
* Work is accurate and with eye for detail
* Always seeks to improve our customers experience
* Works independently but collaborates effectively
* Ability to solve complex issues that are in the best interest of the customer and the company
* Positively manage stress and foster mutual respect
Manage the implementation of all TPAs, carriers and partner companies such as cost containment, managed care, employer groups, and provider network partners. Communicate effectively with customers and One Call staff in the execution of project management deliverables. Document workflows and monitor outcomes to ensure compliance internally.
* Customer introduction and deliverables communicated
* Internal stakeholders within One Call notified
* Project management plan including workflows developed and organizationally shared
* ID card and referral source review
* Information obtained and customer set-up in system for service delivery, pricing, and administrative fee
* Interface enabling and testing: eligibility/benefit verification, clearinghouse, claims, network, and utilization mgt
* Monitor service to ensure customer expectations are met and/or make changes to internal flows or joint workflows as necessary
* Identify areas of improvement, in conjunction with functional unit leadership, to make needed process changes
* Validate existing customer renewals or new adds monthly and communicate to scheduling team
Manage the reporting needs of all TPAs, carriers and partner companies such as cost containment, managed care, employer groups, and provider network partners.
* Responsible for production, quality assurance and distribution of monthly and/or quarterly cost savings and utilization customer reports (external)
* Responsible for production, quality assurance and distribution of customized/ad hoc reports when requested by customers (external)
* Work with IT to create reporting efficiencies and value-added reports for the customers when feasible (internal)
* Maintain, update and distribute monthly customer implementation report (internal)
* Maintain, update and distribute monthly customer referrals and schedules report (internal)
* Verify quarterly producer overrides
Direct the customer complaint management and response process.
* Communicate customer issues immediately to appropriate departments within One Call
* Ensure complaints are logged in Sf.com or other database
* Identify trends in complaints
* Work with Provider Relations, Finance, Customer Service, Service Operations and other areas to resolve process issues causing complaints
* Keep Sales and Management informed of complaints, trends and resolutions
Monitor the overall service delivery process internally.
* Review scheduling success rate and identify feasibility and means of improving this ratio
* Assess scheduling TAT and ensure it meets customer needs/expectations
* Evaluate claim submission TAT including underlying components of provider HCFA collections, HCFA EDI submission and collection of payer and member responsibilities
* Work effectively with Service Operations and Finance to put in place optimal flows to support these activities
* Assess the performance of payers in claim processing. Work with Finance to receive reporting and jointly review to identify areas of improvement. Work with payers when feasible to improve processing quality or timeliness
* Review provider network needs/requests for Group Health customers. Communicate contracting/price needs to Network Development and monitor progress
* Partner with IT, Service Operations, Finance and Network Development on all Phoenix enhancements related to Group Health including the prioritization of items, design and review of test results
* Manage annual and ongoing strategic initiatives supporting Group Health as agreed upon by management
841 Prudential Dr, Suite 204
Jacksonville, FL, 32207