This job supervises and coordinates the day to day activities of the UM Intake Coordination team. The incumbent selects, develops and continuously coaches staff to the highest levels of performance. Motivates and team builds through the creation of a work environment and conditions that contribute to highest levels of performance.
- Perform management responsibilities including, but limited to: involved in hiring and termination decisions, coaching and development, rewards and recognition, performance management and staff productivity. Plan, organize, staff, direct, and control the day to day operations of the department; develop and implement policies and programs as necessary; may have budgetary responsibility and authority.
- Determine workflow for the day and assign work to the team. Monitor and manage daily inventories to ensure adequate staffing and resources are available to ensure performance guarantees and established goals are met and maintained. Monitor calls for quality assurance and compliance.
- Research quality issues and responds to error assessments. Maintain department logs and documentation, analyze for trends in order to identify and initiate future pro-active measures. Produce and analyze reports through various systems and databases, focusing on productivity, quality and compliance.
- Ensure compliance with all regulatory entities (i.e., DOH, CMS, NCQA, etc.) Create, implement, monitor and report on the policies and procedures to ensure all required business/compliance standards are met. Represent the department in compliance audits as it relates to the supervisor functions.
- Act as subject matter expert for benefit plan and claims processing
- Research and investigate any privacy or compliance concerns (CMS, HIPAA, internal policy, etc). Complete root cause analysis and address remediation process with impacted employees.
- Participate in process improvement initiatives as appropriate, which may involve working across teams and with different levels of management.
- Troubleshoot escalated cases, which may involve speaking with providers via phone. At times, build cases in Utilization Review system during high volume times.
- Other duties as assigned or requested.
- High School Diploma/GED
- 5 - 7 years of Customer Service experience
- 1 - 3 years of Management experience
- Oral & Written Communication Skills
- Telephone Skills
- Problem Solving & Decision Making
- Healthcare Industry
Referral Level: 1
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