Senior Manager - Operations Payer - Provider Data Management

This opportunity is with a reputed Healthcare BPO client.

Sr Manager Operations - PDM - Provider Data Management

Mandatory: Ideal candidature would be 8-12 + YEARS OVERALL EXPERIENCE WITH MIN 7+ years

of work experience in PDM domain IN USHEALTHCARE PAYER OPERATIONS

(A) As a Strategic Thinker:

- Transition Planning and Coordination

- Identifying Value additions and Process Improvement Initiatives

- Process Metrics review with the senior management and the team

- Identifying, recommending, and implementing ways to increase the productivity and the quality of the team

- Adherence to company policies

- Ensuring the process meets the defined Service Levels

- ISO and HIPAA compliance

(B) As Driving Results:

- Creating Growth Path/Succession Planning for the process

- Effective Resource Utilization

- Define and review KRA of Leads, AMs & DMs

- Manages day to day Operations

- Timely reporting of deliverables like Performance Incentive, Internal Dashboards

- Responsible for timely invoicing.

- Attend to Process Escalation and provide effective solutions

- Responsible for Balance Score Card and its parameters

- Attend to Client calls, Status Meeting and Client Feedback.

- Review and Regulate SOP

- Is able to identify problems and take decisions independently

- Provides solutions to individual and organizational challenges

(C) As a Partner with Clients:

- Co-ordinate on Process Quality requirements

- Passion for excellence

- Driving Perfect Service

- Driving Formula one and other Developmental Programs for the team

- Identifying, recommending, and implementing ways to increase the productivity and the quality of the team.

(D) Lead People

- Managing Self

- Identify and participate in training / developmental programs

- Inspiring Others / Managing Teams

- Control Absenteeism and Attrition in the Process

- Coaches and mentors AMs & DMs

- Hiring as per the process requirements

Mandatory Skills & Qualifications:

Domain Skills:

- Provider Enrolment (Provider Enrolment with US Ins, ERA and EDI.)

- Create Group or Individual NPI for New provider.

- Credentialing / Re Credentialing (to Enroll the providers with the Insurance)

- CAQH & PECOS Expiable & Attestations

- Create profile for Providers on CAQH and PECOS.

- Data collection and verification (Directory)

- Provider Matching

- Client On boarding

- Managing provider CAQH, Expirable Management, PSV, Client Onboarding, Application

Management, Insurance follow-ups.

- Create Group or Individual NPI for New provider through NPPES and I&A system.

- Provide enrolment report to US SAM/JAM for their client

- ERA and EDI Enrolment through Clearinghouse.

- US health care (ERISA/HIPAA/State Mandates)

- Practitioner/Facility Updates and maintenance

- Provider On boarding

- Contract Loading

Operational Skills:

- Willing to work in flexible shifts (Mid shift)

- Minimum Span Management should be 150+ FTE

- Exposure to Client Management

- Exposure to P&L Management

- Awareness of Statutory Compliances like ISO, ISMS

- Exposure to Business Excellence/ Improvements Projects

- Stakeholder Management

- Minimum 7+ years of work experience in PDM domain

Intrapersonal Skills:

Educational Skills:

- Graduation/Post Graduation Must

- Lean or Six Sigma Certification is desirable

- Professional Certifications if any

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