Manager

Location

Chennai | India

Job description

TPA offers a full suite of health plan management and back-office services that maximize efficiencies, fulfill regulatory requirements, and assure accurate reimbursement. Our extensive expertise in TPA means your organization can focus on delivering care to your participants, instead of on the technicalities of a health plan.

Job Description: Assistant Manager of Configuration and Provider Network Services

Summary: Under the guidance of the Director of Provider Network Services, the Assistant Director of Configuration and Provider Network Services is the right hand to the Director. This role develops, directs and manages all aspects of claim processing systems, training departmental staff, and serves as a liaison to Claims, Sales, Service and Implementations, as well as the Migration Team. S/he will be responsible for ensuring clients benefits and provider contracts/payments are properly loaded and configured to maximize automation and accuracy of data populating downstream extracts such as, and that data is submitted to CMS and states as required for risk adjustment, encounter data, provider 835 payments and internal/external data warehouses

Essential Functions:

System Responsibilities

. Assist with the leading of the configuration of client's rules, benefits, members, and providers in concert with the Director

. Oversee the submission and tracking of support tickets for processing system, and report bottlenecks

. Ensure policies, procedures and formal delegations are in place to maintain effective coordination and control of configuration, provider network, and regulatory department activities

. Ensure that service and product standards are in place and that programs and training are in place to assure consistent achievement of targets

. Regularly evaluate policies and procedures to ensure consistent application and effective operation

. Evaluate and ensure overall quality of service delivery process and illuminate vulnerabilities early for mitigation

. Recommend alternative strategies to improve effectiveness of operations

. Establish measures and processes by which to collect, monitor, evaluate, and report on key performance indicators

. Ensure the information and data integrity of the processing systems

. Continually increase the use of data as a basis for making business decisions

. Assist in the exploration and evaluation of in-house or purchased technology solutions for current and future business needs.

. Instill and reinforce an outstanding service culture for internal & external customers

. Take prompt and decisive corrective action when necessary to ensure achievement of financial, operational, quality and service goals

Management support for business evolution and process improvement

. Assist in the evaluation of department readiness and staff preparedness for business evolution and expansion

. Assist in the facilitation of process improvement projects identified, prioritized and assigned across the organization

. Participate in all phases of project management to make certain that the objectives are accomplished on time and within budget and that risks have been identified and properly mitigated

. Facilitate workgroups to identify ways to increase quality and efficiency and business and operations processes

. Assure effective communication as organizational changes are implemented

Talent Management

. Collaborate with Director, HR, parent company and VP/SVP to attract, develop and retain talent

. Provide direct reports with timely and constructive performance feedback

. In accordance with company human resource policies and procedures, review, recommend or approve promotions and salary reviews

. Advise the management team on client issues.

. Ensure all direct reports are fully informed of operational objectives and input is obtained prior to significant operational changes

. Conduct regular meetings with Director, direct reports and staff to communicate priorities and coordination of activities

. Support company-wide performance planning, coaching, appraisal and discipline programs to ensure consistent, fair, and transparent implementation and compliance with company policies and procedures

Additional Functions:

. Assist Director with team meeting agendas, recognitions, etc.

. Communicate clearly and concisely, with sensitivity to the needs of others

. Maintain courteous, helpful and professional behavior on the job display a willingness and ability to be responsive in a warm and caring manner to all customer groups consistently cooperates and supports organization in problem solving issues ensure customer satisfaction will support the success of the entire team establish and maintains effective working relationships with co-workers

. Follow all Policies and Procedures and HIPAA regulations

. Maintain a safe working environment

. Maintain the confidentiality of all company procedures, results and information about participants, clients, providers and employees

. Assist with special projects as requested by the Director

Supervisory Responsibility: Responsible for overall leadership of the Provider Network Specialists, and for direct leadership of the Provider Network Supervisor/Manager, EDI Data Specialists and Configuration Analysts.

Travel: Periodic travel, 10-20%, depending on business needs.

Knowledge, Skills and Abilities:

. Combination of at least 10 years of Medicare/Medicaid and Managed Long Term Care experience in leadership rol.

. MBA or equivalent business experience preferred

. Strong background in operations, financial management, IT and accounting

. Strong people skills and experience supporting a Director

. Outstanding, leadership, management and organizational skills

. Capacity to oversee a complex operation, and the leadership skills to function as a mentor and coach and filter/illuminate items requiring Director's attention

. Ability to budget and forecast demand, revenues and expenses and control costs./minimize overtime

. Understand how to use data to drive & develop business plans and evaluate business trends to modify strategies and corrective actions

. Ability to set and meet high standards of service to develop a work force that embraces a culture of quality and service

. Ability to function effectively, exert influence and gain consensus at all organizational levels, in both direct, matrix and consultative organizational relationships, with internal stakeholders as well as external constituents

. Personal integrity and exemplary ethical standards

. Excellent time management skills and know how and when to impose deadlines and delegate tasks

. A forward-thinking personality who can identify areas for improvement and take decisive and timely action to bring about the desired change

. The ability to attract, train, manage and motivate a skilled team

Physical Demands & Requirements :

. Communicate by way of the telephone with participants, customers, vendors and staff

. Operate a computer and other office productivity machinery, such as a calculator, copy machine, fax machine and office printer

. Remain stationary for extended periods of time

. Visual acuity to perform activities such as identifying, inputting and analyzing data on a computer terminal and/or in hard copy

Work Environment :

. This job operates in a professional or home office environment with a conversational noise level.

#LI-Remote

...This is a remote position. Adequate internet speeds and a suitable home-office environment are required for this position. All new team members will be bound by the 'Teleworking Agreement' and must continually meet the terms of the agreement to maintain remote work status.

Tabula Rasa HealthCare, Inc. is an Equal Opportunity Employer.

Employment is contingent upon a successful background/drug check.

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