Provides leadership and management oversight for all aspects of the PMSI Bill Review product and related processes. This position o versees departmental process improvement initiatives including establishment and refinement of various business processes, and new operational capabilities, Bill Review programs and products intended to service a dynamic customer base. The Senior Manager of Bill Review is responsible for the program design and implementation of the PMSI Bill Review product. Works closely with other departments to improve business results, interdepartmental workflows and efficiencies.
n Drives the implementation of new technology, clients, business processes and procedures and enhancements to existing technology, processes and procedures. Documents all workflows of the operational business model for departmental needs as well as processes which may impact other departments.
n Develops and manages operational relationships with external vendors in the areas of bill review and scanning/document management.
n Works effectively with other business units including IT to revise any support processes to enhance service delivery and operational effectiveness.
n Primary interface to Governmental Affairs to ensure compliance with state laws and requirements specific to state reporting and fee schedules
n Partners with the entire PMSI client base in conjunction with Client Business Solutions, Client Services, and Sales, providing pre and post bill review/program compliance support relating to workflow, processes and operational support for the purpose of resolving issues, and recommending opportunities for continual process improvement.
n Provides mentorship to Bill Review team to help them to successfully liaise with all internal departmental personnel for the purposes of identifying and conveying potential impacts that result from ongoing Bill Review business process improvement efforts.
n Works with Executive leadership on initiatives to develop and implement new business opportunities, programs, products and enhancements to gain additional revenue.
n Partners with Client Business Solutions, Client Services, Bill Review Supervisors, Human Resources, Training Specialists, Program Compliance Specialists, Managers and Directors on new Pharmacy and bill review client implementations, with an emphasis on the requirements of associate training, documentation, staffing, business requirements and product changes.
n Works with Manager of Bill Review and external bill review & scanning vendors to ensure consistency in service levels provided to Pharmacy, in the area of issue management, application updates/modifications and resulting impact to bill review & scanning processes. Performs analysis of new vendor solutions and product offerings to broaden service level offerings to Pharmacy client base.
n Partners with Pharmacy leadership to ensure consistency in Pharmacy Review Services, Provider Relations and Support Services operations via the review of key data elements and reports obtained during all program penetration, referral and bill review activities for the purpose of identifying problems or business process improvement opportunities.
n Works with Managers, Supervisors, Program Compliance Specialists and Training Specialists to guide in the development and implementation of departmental guidelines, work processes, and workflows that allow achievement of key performance measurements and continuous improvement of the operation.
n Performs other functions as assigned by management.
n Analytical Skills – Ability to analyze and synthesize information to understand issues and identify options.
n Understanding the Business – Ability to know the business and the mission-critical technical and functional skills needed to do the job; understands various types of business propositions and understands how businesses operate in general; learns new methods and technologies easily. Understands the organization’s business model and competitive position in the marketplace. Understands potential for growth and profitability.
n Managing Diverse Relationships – Ability to relate well to a wide variety of diverse styles of people, types, and classes; open to differences; effective up, down, sideways, inside, and outside; builds diverse networks; quick to find common ground; treats differences fairly and equitably; treats everyone as a preferred customer.
n Managing Work Processes – Ability to effectively design work flow, and systems; is good at figuring out what to measure to track progress; sets up systems that can almost manage themselves; is a master at the effectiveness and efficiency of work systems; can quickly diagnose and fix a work flow problem; always looking for incremental process improvement.
n Project Management – Ability to bring projects to completion eliciting the collaborations of interdepartmental team members.
n Time Management – Ability to manage one's own time and the time of others.
n Motivating & Delegating – Ability to manage people well; gets the most and best out of the people he/she has; sets and communicates guiding goals; measures accomplishments, holds people accountable, and gives useful feedback; delegates and develops; keeps people informed; provides coaching for today and for the future.
n Driving Execution – Ability to assign clear authority and accountability; direct change while maintaining operating effectiveness; integrate and align efforts across units and functions; Monitor results; Tackle problems directly and with dispatch.
n Treats people fairly – Ability to treat all stakeholders with dignity, respect and fairness; listens to others without prejudging, objectively considers other people’s opinions.
n Organizational Skills – Ability to multitask and manage multiple projects
n Flexibility – Ability to work in a fast paced environment.
n Computer skills – Possesses intermediate to advanced Microsoft Suite Knowledge (Word, Excel, PowerPoint).
n Communicating Effectively – Ability to write and present effectively; adjusts to fit the audience and the message; strongly gets a message across.
n Detailed Oriented – Ability to be well organized and resourceful, has the ability to reduce a complex concept or task into something that is manageable and clearly interpreted. is able to get things done with less and in less time; can work on multiple tasks at once without losing track; foresees and plans around obstacles.
n Team player – Ability to manage strong working relationships within the company. Able to complete tasks and work cooperatively with others.
n Adaptability - Ability to respond and adapt to changing circumstances and to manage, solve problems and provide solutions in a climate of ambiguity.
n Required: BA/BS degree in Business Administration/Management and 7+ years of accounting/financial or operations experience.
Desired: Masters degree in Business Administration/Management
n Required: 7+ years management experience in customer relationship management. Experience with call center technologies including ACD, CTI, CRM and reporting analysis. Experience managing and interfacing with senior level personnel. Proven financial analysis experience. Proven business process reengineering experience. Operational management, project management, vendor management (external suppliers/customers).
n Desired: Prior experience in health care/workers’ compensation, bill review, call center management.
n Required: N/A
n Desired: N/A
n Total Number of Associates this position oversees: 10-20
n Number of Direct Reports: 1-5
n Title(s) of Direct Reports: Bill Review Manager
The work environment characteristics described here are representative of those an associate encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. The noise level in the work environment is generally quiet to moderate.
PhYsical and mental requirements:
The physical demands described here are representative of those that must be met by an associate to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions:
1. Sedentary physical activity requiring reaching, sifting, lifting, finger dexterity, grasping, feeling , repetitive motions, talking and hearing.
2. Visual requirement is for close vision, distance, vision, peripheral vision and ability to adjust focus.
3. 50% or more time is spent looking directly at a computer.
4. Associate is frequently required to stand, walk (or otherwise be mobile).
5. Ability to deal with stressful situations as they arise.
PMSI - 2 years ago