The Manager of Provider/Member Systems is responsible for performing a broad variety of duties relating to customer service for both the Member and Provider clients. These duties include, but are not limited to data collection, validation and maintenance of member and provider demographics, account information, provider assignment, claim issues, authorization status and various account issues. In addition, the position will be responsible for the development, oversight and monitoring of a member retention program that is designed to grow and maintain membership.
The Provider/Member Systems Manager works as a liaison between staff and Senior Management to communicate opportunities for improvement and resolve issues/questions regarding health care services. This position is responsible to compile and analyze plan data to identify trends and opportunities in order to drive effective performance results, with will contribute to high member retention and satisfaction.
The Member Services Manager provides training, guidance and oversight to the Member Services staff to ensure the department meets the company’s strategic goals.
Essential Functions and Responsibilities of the Job
Plan, direct, supervise and coordinate work activities: balance workloads; manage performance; assess training and development needs; resolve complex member/provider issues; provide oversight and trouble shoot core systems.
Ensure adequate coverage; and monitor departmental budget for staff, supplies and meeting costs.
Comfortably delegate responsibilities, tasks and decisions; appropriately trusts others to perform; provide support without removing responsibility
Independently research and compile data from a variety of resources, evaluate and analyze data, prepare detailed information, reports and recommendations on behalf of assigned executive(s)
Provide support to the executive team; manage office resources; act as a liaison for internal and external customers.
Minimum of 3-5 years management experience with 2+ in customer service, preferably within the healthcare industry
5 years or greater of managerial/supervisory experience
Lean methodology experience preferred
Successful analytic acumen
Comprehensive knowledge of federal and state regulations pertaining to managed care, including knowledge of Medi-Cal, Medicare and DMHC guidelines.
Strong critical thinking skills and the ability to make timely, professional and ethical decisions.
Excellent organizational, interpersonal, communication and coaching skills.
Computer proficiency (MS Word, PowerPoint, and Excel)
Knowledge of Trans Union application and MHC application preferred
Excellent verbal, written and presentation skills
High school graduate or equivalent required.
Bachelor's degree preferred, or equivalent on the job experience (business, health administration, public health, or related field)