Manager, Provider Research

Responsibilities

• Manage staff, ensuring provider inquiries are responded to timely, accurately, and professionally. Resolve complex provider inquiries.
• Respond to and oversee staff responding to CMS demand letters.
• Participate in ad hoc projects to help enhance the provider experience with HMSA. These may include but are not limited to enhancements of provider online resources and development of content for the Health Pro news and Provider Resource Center.
• Analyze relevant data sources to proactively help identify and resolve issues affecting providers.
• Oversee training activities and the creation of training materials, workflows, and desktop procedures. Prepare and conduct presentations for staff and management.
• Develop staff in a manner that ensures continual growth and opportunities while maximizing efficiency for providers and the department.
• Integrate Claims Adjustment Specialists into the Research and Correspondence unit by implementing a plan for the pend resolutions to be worked and ensuring audit compliance.
• Lead the Research and Correspondence team in technological initiatives including existing application upgrades, adopting new applications, and ongoing refinement of the team's use of the Sales Force application.
• Coordinate reporting requirements for the unit including but not limited to inventory management reports and ad hoc claim queries.
• Performs all other miscellaneous responsibilities and duties as assigned or directed.

• Bachelor's degree and five years of related work experience; or an equivalent combination of education and related work experience.
• One year of experience in a management/supervisory/leadership role.
• Excellent verbal and written communication skills.
• Excellent customer service skills.
• Basic knowledge of Microsoft Office applications. Including but not limited to Word, Excel, and Outlook.