UPMC Health Plan’s Medicare HCC group is seeking a Manager of Operations for their Risk Risk Adjustment Government Revenue team!
If you have Supervisory experience in addition to Medical Records Abstraction experience, this role is perfect for you!
The Manager of Operations will lead implementation activities that support UPMC Health Plan’s Exchange strategy, including UPMC Health Plan’s participation in the Individual Public Exchange Marketplace. This position is responsible for creating and/or overseeing processes to ensure preliminary and ongoing compliance with all ACA regulations, including but not limited to ensuring UPMC Health Plan meets all filing and reporting requirements.
This position is work-from-home while also requiring travel to sites 50% of the time. Travel is within two hours of the employee’s home.
- Provide direct managerial oversight and general direction to overall abstraction operations.
- Actively review and manage data outcomes to identify opportunity for overall status and improvement.
- Ensure complete, accurate, timely and consistent abstraction according to the standards of various internal, regulatory and coding policy.
- Knowledge of medical terminology and coding is essential for this position.
- Analytical skills and attention to detail are necessary to understand and follow medical records, and determine errors or missing information.
- Must exercise integrity to protect patient confidentiality.
- Technical skills with database and software are also necessary, as well as strong computer skills.
- You must have excellent oral and written communication skills to converse with physicians and other employees
- Coordinates functions and communications throughout the organization as a hub to ensure the successful delivery of the Exchange program.
- Assist Compliance/Quality Audit in responding to audit findings and ensure teams are assembled to address deficiencies.
- Perform requirements gathering, design, testing, and implementation of annual renewal process for ACA membership.
- Assesses program capacity and capabilities for managing Health Insurance Exchanges and oversees key business functions, processes and the departments supporting Exchange.
- Manages the implementation of new CMS Exchange product requirements and delineates operational ownership to the appropriate department(s) to ensure they support business objectives and meet all compliance requirements.
- Proactively identify opportunities to improve processes, draft business cases to support necessary changes, ensure required program and project work gets prioritized and added to Exchange track work plans. Work closely with department teams in the various Exchange tracks to implement recommended changes.
- Develops and continually improves strategies, objectives and policies for the Exchange program and identifies and resolves any issues that may hinder program success
- Work with Compliance/Quality Audit to manage process to collect, review and submit risk, quality, and service metrics reporting and ensure reports are submitted as required.
- Coordinate with other departments to overcome challenges that affect the overall success of the ACA Individual Advantage product.
Review, monitor, and incorporate new member communication notices and strategies to maintain membership and adhere to CMS regulated guidelines.
- Bachelor’s Degree in Business Administration or related field experience
- Three or more years of supervisory experience in an HMO or other managed care organization, including experience managing large, complex, cross-functional projects in a large matrix organization
- Prior Medical Records Abstraction experience
- Team management experience.
- Process and workflow expert.
- Data and performance metric development and tracking required.
- Knowledge and ability to apply advanced features of MS Office applications (Word, Excel, and PowerPoint) and ability to operate database management systems (Access proficiency preferred)
- Excellent organizational skills Excellent relationship building skills
- Excellent verbal, written and presentation skills, including ability to prepare and deliver presentations in a variety of formats and to a variety of audiences
- Ability to perform well under pressure when dealing with different types of work and competing and changing priorities
Ability to deal with complex situations
Licensure, Certifications, And Clearances
UPMC is an Equal Opportunity Employer/Disability/Veteran
More than just competitive pay and benefits, UPMCâ€™s Total Rewards package cares for you in all areas of life â€” because we believe that youâ€™re at your best when receiving the support you need: professional, personal, financial, and more.
At UPMC, weâ€™re driven by shared values that guide our work and keep us accountable to one another. Our Values of Quality & Safety, Dignity & Respect, Caring & Listening, Responsibility & Integrity, Excellence & Innovation play a vital role in creating a cohesive, positive experience for our employees, patients, health plan members, and community. Ready to join us? Apply today.