Job Description

Not Applicable Qualification :Graduate /Post Graduate - preferably MBA graduates Knowledge of CRM tools & MS office tools For Medical Management and Provider Services Bachelor\'s Degree in Nursing (BSN). For Philippines 34 year college degree preferably related to medical field (as mandated by the project). For NA High School/Equiv, Associates Degree preferred or equiv work experience. Responsibility : Business / Customer : . Certify controls laid down by the business to ensure successful audit by client and external party. . Interact with customers (internal / external) and keep stakeholders appraised of the process performance. . Create status reports for customers (internal/external). . Manage and resolve escalations and issues raised by customers and process specialists. . Ensure adherence to Quality norms and procedures. . Identify & drive opportunities not limited to Cost Optimization and Process Excellence to enhance service delivery. . Provide client/process related MI reports. . Interface with the management both in terms of cascading messages from senior management and putting into practice strategy or modifications required for the process based on decisions taken. . Identify & drive opportunities to enhance customer experience. . Anticipate issues and needs of the customer related to the project and address them proactively. thereby help achieve CSS targets. For Claims, Medical Management & Provider Services : . Communicate with the client counterpart on a daytoday basis on daily scorecards. For NA TM : . Participate in Customer review / governance meetings to discuss on Service performance, project issues and improvement opportunities. . Anticipate issues and needs of the customer related to the project and address them proactively. thereby help achieve CSS targets. Project / Process : For Medical Management, RCM and Provider Services : . Ensure timely completion of tasks assigned to all team members. . Develop SOPs and training Manuals. . Generate periodic performance reports and dash boards for the process. . Capture relevant metrics periodically. . Communicate resource issues to Operation Manager. . Inform the teams of any process updates and document the same. . Review and update domain specifics. For Provider Services : . Communicate SLA to enabler functions based on timeframes. . Actively participate in discussions with the Quality / PEX teams to identity process improvements. . Lease with NSS to ensure Telecom connectivity & Proper Working of workstation as per specification. . Lease with Admin for Transportation & all other admin related work. . Lease with HR for on time & quality recruitment. . Track Project Performance Quality & Quantitative Metrics. . Ensure adherence to Quality norms and processes. . Adhere to security practices set by organization. . Maintain confidentiality of all information, policies, and procedures as required by the Health Insurance Portability and Accountability Act (HIPAA) protocols. For Medical Management and RCM : . Oversee daily operations, processes to ensure that all quality and efficiency standards and targets are met. including but is not limited to daily completion rate, accuracy of data encoded in the review, attendance and adherence to company protocols. . Oversee the performance of new on boards and ensures coaching of the team. . Analyze areas for improvement for meeting program objectives and participates in establishing Quality Improvement Projects for the program. . Provide weekly coaching to the team in relation to their scope of work. . Cascade essential information and updates to team through the weekly meetings. . Provide regular and periodic feedback to the Program Manager on the team performance for coaching and appraisal purposes. . Ensure that immediate supervisors are appraised on significant program activities, issues and concerns through emails, meetings and weekly reports. . Handle staff questions and escalation as necessary. . Perform senior process executive functions as needed. . Supervise the hiring process. . Review all QC and QA reports and reinforce corrections and suggestions made the quality reviews team. . Collaborate with the team and clients and assists the Operations manager with managerial activities as needed. . Reward and discipline employees. address complaints and resolve problems. . Coach and develop Nurse Reviewers, Administrative Staff, Subject Matter Experts (SME), and Team Lead to promote an understanding of the company culture, policies, goals and procedures. For Claims, NA, RCM and Member Services : . Support Knowledge transfer at the time of process transition from the business site. . Drive team to achieve process Service Level Agreements / metrics ie productivity and quality targets within the established timelines. . Ensure compliance controls are met. . Ensure documented process guidelines are followed. conduct periodical reviews for process adherence. . Conduct adhoc Quality checks. . Review process audit findings and take corrective action. . Innovate ideas to error proof the process & reduce manual interventions. . Conduct process training or refresher trainings, if required. . Maintain operations rigor around daily huddles, visual management, knowledge management, cross training etc. . Initiate and deliver on process improvement projects to improve process efficiencies. . Provide updates and submit reports related to own area of work. . Ensure optimum resource utilization through cross training initiatives and buffer management. . Interface with other departments for getting required assistance or support for the team. . Engage with other processes to understand and implement best practices. . Lead calibration initiatives with the client and for the team. . Drive a culture of continuous improvement within the team. For NA : . Provide updates and submit reports related to own area of work. . Is the escalation contact for clients and internal stakeholders. . Ensure all data update requests are tracked and status updates provided to management. . Plan resource rotation to comply with Organization / Business Unit recommended Pyramid and Span. . Manages project risks and issues, ensuring that project team members are actively involved in the identification and where appropriate the ownership of risks, initiating corrective action where necessary. For NA TM Only : . Follows customer profitability practices such as Cost optimization methods, productivity & quality benchmarking, periodic target revision etc. . Ensure tracking and collating of Quality (internal, external & client facing) data is performed accurately through BPS Quality Report. . Participate and provide inputs during Solution development activities Build relationships with line managers or portfolio owners in the customer organization. . Share best practices with the Organization and leverage Organization assets for the benefit of the project. . Establishes the key calendar of events for the project / LOB. . Identify and highlight areas of risk in the process. People / Team : . Ensure appropriate distribution of work among direct reports. . Responsible for creation and implementation of learning plans and skill upgrade. . Responsible for Performance management and career development of the team members. . Encourage Team to contribute and participate in training programs. For Medical Management, RCM and Provider Services : . Ensure completion of training plan for all direct reports. . Responsible for driving Reward & Recognition and employee engagement. For NA, Claims, RCM, Provider Services and Member Services : . Guide and mentor team members. . Groom self and team to support vertical/business growth. . Conduct team building activities to enhance motivation. . Conduct regular 101s to gauge the pulse of the team members. . Complete mandatory training for self as identified in the training plan for the project. . Review VOC scores, provides feedback and recommend refresher training whenever necessary. . Report to the manager on per. Must Have Skills Technology Skills Automation

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