Partner at InnoQuest Consulting
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Senior Manager - Operations Payer - Provider Data Management (9-15 yrs)
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:
- 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
- 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
- Graduation/Post Graduation Must
- Lean or Six Sigma Certification is desirable
- Professional Certifications if any