Supervisor, Provider System Information Admin

Description:

GENERAL SUMMARY

Guides and drives the development and activities of an organized team responsible for analyzing, coding and building provider demographic and payment information and/or client provider network information into the

transactional system and associated databases. Supervises the day to day operations of a team. Serves as a consultant to the health plan and customer service/claims regarding system capabilities and limitations.

ESSENTIAL RESPONSIBILITIES

- Supervises an organized team of cross-functional members to meet or exceed service requirements.
- Independently examines and analyzes the team’s performance against measured goals; demonstrates ownership for overall team results; recommends and leads the implementation of plan(s) of action to improve the team’s service level. Provides structured coaching and counseling as appropriate.
- Drives the team to identify and implement process improvements; encourages ownership and group participation toward improvement initiatives (eg auto-adjudication).
- Serves as technical consultant to health plans and customer service/claims regarding highly complex data interpretation requests and in developing new products and strategies.
- Leads and participates in cross functional task forces to identify and document functional needs, work flow, information sources and distribution paths, along with system specifications/enhancement requirements.
- Analyzes the impact of process or technical changes on existing processes and interfaces, based on cross-functional knowledge of transaction systems and CSO operations.
- Coordinates team resources to support health plan and customer service/claim initiatives. Becomes directly involved with execution of team processes and functions as required.
- Develops and conducts presentations and Billing Office Reviews and health plan/CSO training including, but not limited to, contract and provider maintenance process, policies and procedures, implementation tasks associated with plan initiatives.
- Oversees the evaluation and installation of highly complex provider demographic and payment information and/or client provider network information into the transactional system and other databases.
- Extracts and interprets data from transactional system and departmental databases for analysis, system set-up and plan initiatives.
- Performs other duties as required.

Qualifications:

JOB SPECIFICATIONS

- High school degree or equivalent. Bachelor’s degree preferred.
- Significant experience (4-6 years) in health care, with progressively more complex responsibilities and accountabilities. 1-2 years supervisory experience preferred.
- Demonstrated leadership and motivational skills.
- Strong skills required in critical thinking and analysis, meeting facilitation, verbal and written communications and interpersonal interactions (eg, partnering, conflict management, consulting, etc.).
- Understanding of health care business and care delivery processes.
- Travel to health plans or CSO locations is required.
- Ability to work on cross-functional teams to drive change.
Coventry Health Care is an Affirmative Action/Equal Opportunity Employer, and we are committed to building a talented and diverse team.

Job: Professionals
Primary Location: West Sacramento, CA, US
Other Locations: ,
Organization: 10750 - Service Center - Central Admin
Schedule: Full-time
Job Posting: 2013-05-13 00:00:00.0
Job ID: 1311629