Manages the day-to-day responsibilities of the regional operations account management team specifically related to Provider contracting and payment issues both internally & externally. Partners with director to establish appropriate processes and monitors daily performances as it pertains to the production, quality, and service to ensure that company goals and departmental metrics are met. In connection with provider operations and regional staff, partners with director to design and implement processes to remediate identified root cause issues.
REPORTS TO: Director, Operations Account Management DEPARTMENT: OPS - National Account Management POSITION LOCATION: Brentwood, Tennessee
Monitors goals and works closely with account managers to drive performance and to ensure provider satisfaction metrics are met or exceeded.
Applies analytical tools and techniques to identify root causes, prevalence and impact of issues across multiple states/business units. Develops strategies to reduce problems and improve efficiency over time.
Tracks and trends root causes to develop systematic solution to operational challenges.
Recruits, selects, trains and retains highly qualified professionals. Provides the leadership necessary to maintain a motivated, productive and competent team through open communication and delegation of responsibilities and authority.
Provides support to staff by answering questions and resolving technical issues.
Manages oversight on issue resolution.
Manage and oversee activities to ensure that services comply with governmental and accrediting agency regulations.
Ensures the delivery of superior customer services by providing timely and accurate resolution to claims and credentialing related provider inquiries and complaints regarding inventory processing.
Manages and develops direct reports who include other management or supervisory personnel and/or exempt individual contributors.
Partners with director to set operational priorities and manages resources to operational goals and budgets.
Identifies opportunities to improve department results, communications and operating efficiencies.
Manages workload and assignments, measures performance and initiates personnel actions as necessary.
Perform other duties as assigned.
Required A Bachelor's Degree in a related field
Required or equivalent work experience
Required 5 years of experience in Managed care, preferrably operations management, claims processing/issue resolution or provider contracting environment
Required 2 years of experience in In a role supervising or leading others
Preferred Other Robust experience with operational process and root cause analysis
Required Other Data and work process analysis and problem identification
Preferred Other Medicare and/or Medicaid experience
Advanced Demonstrated written communication skills
Advanced Demonstrated interpersonal/verbal communication skills
Advanced Knowledge of healthcare delivery
Intermediate Ability to lead/manage others in a matrixed environment
Intermediate Ability to influence internal and external constituents
Intermediate Ability to work in a fast paced environment with changing priorities
Intermediate Demonstrated leadership skills
Intermediate Demonstrated analytical skills
Intermediate Ability to implement process improvements
Advanced Other Facilitative skills
Advanced Other Quantitative analysis and financial modeling capabilities
Licenses and Certifications: A license in one of the following is required: Technical Skills:
Required Advanced Microsoft Access
Required Advanced Microsoft PowerPoint
Required Advanced Microsoft Outlook
Required Advanced Microsoft Excel
Required Advanced Microsoft Visio
About us Headquartered in Tampa, Fla., WellCare Health Plans, Inc. (NYSE: WCG) focuses primarily on providing government-sponsored managed care services to families, children, seniors and individuals with complex medical needs primarily through Medicaid, Medicare Advantage and Medicare Prescription Drug Plans, as well as individuals in the Health Insurance Marketplace. WellCare serves approximately 5.5 million members nationwide as of September 30, 2018. WellCare is a Fortune 500 company that employs nearly 12,000 associates across the country and was ranked a "World's Most Admired Company" in 2018 by Fortune magazine. For more information about WellCare, please visit the company's website at www.wellcare.com. EOE: All qualified applicants shall receive consideration for employment without regard to race, color, religion, creed, age, sex, pregnancy, veteran status, marital status, sexual orientation, gender identity or expression, national origin, ancestry, disability, genetic information, childbirth or related medical condition or other legally protected basis protected by applicable federal or state law except where a bona fide occupational qualification applies. Comprehensive Health Management, Inc. is an equal opportunity employer, M/F/D/V/SO.