Manager Managed Care Claims

CommonSpirit Health•Camarillo, CA

About The Position

The Manager, Operations Enablement will be a key leader of the central operational areas listed and report to the VP of Operations and Data Engineering. This manager will have oversight of numerous management responsibilities and support several cross functional capabilities; Benefits/Enrollment, Claims Operations, Eligibility/EDI and other overall implementation efforts that support these assigned transactional operational functions of the MSO. This manager will also operationalize and enable processes across these areas to support internal partnerships. Responsible for leading and developing a team of claims trainers, and business analysts who support the operational excellence and quality improvement of the claims processes and analyst support to the organization. Works closely with the claims directors, benefit/enrollment managers, and supervisors to identify training needs, design and deliver training programs, monitor and evaluate training outcomes, and provide ongoing coaching and feedback. Collaborates with internal change management to identify and implement best practices, process improvements, and innovative solutions that enhance the efficiency and effectiveness of these operational areas. Overall identification and develop recommendations for training playbooks, process improvements, efficiencies for the assigned operational areas. Ensuring stakeholder and leadership alignment to correlating processes throughout the MSO. Manage and coach a team of business analysts, and claims trainers who provide operations shared services to the PHSO. The BA team will provide operational analyst support to all functional areas within the MSO. This will include reporting/analyst deliverables for leadership and/or functional areas, dashboards on functional performance, analyzing report data and accepting and intake of internal stakeholder requests for BA support. Oversee the design and delivery claims training programs and materials that enhance the skills and knowledge of the claims staff and providers. Develop SOPs, DLPs for assigned areas, product recommendations, raise or address operational gaps, and continuously look for ways to improve the business and member/provider experience Support claims operations on provider claims payment investigation and resolution of known errors, developing streamline processes to support the business.

Requirements

High School Graduate or GED
5+years experience required in healthcare administration environment, with an understanding of managed care services and implementing/enabling new processes.
5+ years of experience implementing and enabling new processes with crossfunctional teams
3+ years of people management experience, with a preference for experience managing team members under different functional responsibilities

Nice To Haves

Bachelors Other in business, healthcare administration or similar field, upon hire
10+ years of experience implementing and enabling new processes with crossfunctional teams, upon hire
5+ years of experience in implementing and enabling new processes with crossfunctional teams in a healthcare, managed care services environment., upon hire

Responsibilities

Lead and develop a team of claims trainers, and business analysts who support the operational excellence and quality improvement of the claims processes and analyst support to the organization.
Identify training needs, design and deliver training programs, monitor and evaluate training outcomes, and provide ongoing coaching and feedback.
Collaborate with internal change management to identify and implement best practices, process improvements, and innovative solutions that enhance the efficiency and effectiveness of these operational areas.
Identify and develop recommendations for training playbooks, process improvements, efficiencies for the assigned operational areas.
Ensure stakeholder and leadership alignment to correlating processes throughout the MSO.
Manage and coach a team of business analysts, and claims trainers who provide operations shared services to the PHSO.
Oversee the design and delivery claims training programs and materials that enhance the skills and knowledge of the claims staff and providers.
Develop SOPs, DLPs for assigned areas, product recommendations, raise or address operational gaps, and continuously look for ways to improve the business and member/provider experience
Support claims operations on provider claims payment investigation and resolution of known errors, developing streamline processes to support the business.