Location
Bhubaneswar | India
Job description
JD role 1-US Health care Payer( Client Benefit services )
Qualification Requirements :
15+ years of experience in Healthcare industry (primarily in Payer domain)
Strong understanding of benefit configuration, pricing configuration, claims testing and claims administration
Good understanding on CPT/HCPCS procedure code, revenue code and ICD 10 knowledge
Knowledge on analysis and documentation that supports configuration, design requirements, testing and audits
Knowledge on support for system enhancement in design and testing
Job Responsibilities :
Works closely with Carriers and Internal Management to identify and implement new procedures and processes to improve department efficiencies or as instructed by the Carrier.
Participate and facilitate meetings for decision making, enhancement discussions, problem solving and process improvement.
Answer escalated inquiries from clients, claims and customer service.
Documents policy and procedures.
Governance on daily contribution towards departmental performance and service level guarantees around accuracy and timeliness
JD- Role 2 - Sr. Delivery Manager (US Healthcare payer- Claim Adjudication)
- Experience in managing operations of Health care in Payor domain ( Non Voice). Good understanding of BPM Healthcare Operations from 3rd party and in house Shared Service center perspective. Should have managed Payor processes like claims management,( First Pass and Rework Claims) Enrolment, Appeals Management, Payment Integrity, Provider Data Contracting.
- Sound exposure of BPM Operations like Service Delivery, SLA Management, Governance, Client Management and Engagement
- Handle all facets of operation, HR, Hiring, Finance, Facilities, and Technology Infrastructure etc.
- Work closely with Account Management team to increase revenue. Maintain and build contacts with stakeholders supporting the client on Technology.
- Ability to speak at different forums at the client side and ability to address large crowds internally as well as client senior folks.
- Coordinate resource deployment across all processes for the engagement (Team Size, Span, Shift Utilization, Skill sets, technology rollout) in order to ensure budget & pricing assumptions compliance
- Identify training needs for operation managers and signs off on the engagement training plan in order to ensure competency development across domain, operations and behavioral
- Prepare internal and external governance model in order to track and monitor contractual compliance, employee engagement, performance and relationship health Sign off on the service quality plan including the quality control, assurance and improvement in order to create a comprehensive quality program for the engagement Create the scorecard for the engagement and ensure flow down for the team, in order to align the team with the engagement objectives
- Create career development & succession planning for direct reportees, reviews the career development methodology for the engagement in order to ensure sustainable employee engagement & motivation in the engagement.
- Conduct periodic reviews with ops managers and drives corrective action where required in order to ensure delivery predictability
- Identify Process Pain Points and Transformation Opportunities
- P&L.Areas of Responsibility Prepare the annual budget aligned with corporate divisional objectives for the engagement, coordinate with the account manager for the account plan (New areas of growth) in order to achieve the business objective of the engagement
Member Enrollment(Payer)
Job tags
Salary
