Team Manager

Team Manager (TM)

Qualification:

• For Medical Management and Provider Services Bachelor&rsquos Degree in Nursing (BSN).

• For Philippines 34 year college degree preferably related to medical field (as mandated by the project).

• For NA High School/Equiv, Associates Degree preferred or equiv work experience.

Responsibility:

Business / Customer:

• &bull Certify controls laid down by the business to ensure successful audit by client and external party.

• &bull Interact with customers (internal / external) and keep stakeholders appraised of the process performance.

• &bull Create status reports for customers (internal/external).

• &bull Manage and resolve escalations and issues raised by customers and process specialists.

• &bull Ensure adherence to Quality norms and procedures.

• &bull Identify & drive opportunities not limited to Cost Optimization and Process Excellence to enhance service delivery.

• &bull Provide client/process related MI reports.

• &bull Interface with the management both in terms of cascading messages from senior management and putting into practice strategy or modifications required for the process based on decisions taken.

• &bull Identify & drive opportunities to enhance customer experience.

• &bull Anticipate issues and needs of the customer related to the project and address them proactively.

• thereby help achieve CSS targets.

For Claims, Medical Management & Provider Services:

• &bull Communicate with the client counterpart on a daytoday basis on daily scorecards.

For NA TM:

• &bull Participate in Customer review / governance meetings to discuss on Service performance, project issues and improvement opportunities.

• &bull Anticipate issues and needs of the customer related to the project and address them proactively.

• thereby help achieve CSS targets.

Project / Process:

For Medical Management, RCM and Provider Services:

• &bull Ensure timely completion of tasks assigned to all team members.

• &bull Develop SOPs and training Manuals.

• &bull Generate periodic performance reports and dash boards for the process.

• &bull Capture relevant metrics periodically.

• &bull Communicate resource issues to Operation Manager.

• &bull Inform the teams of any process updates and document the same.

• &bull Review and update domain specifics.

For Provider Services:

• &bull Communicate SLA to enabler functions based on timeframes.

• &bull Actively participate in discussions with the Quality / PEX teams to identity process improvements.

• &bull Lease with NSS to ensure Telecom connectivity & Proper Working of workstation as per specification.

• &bull Lease with Admin for Transportation & all other admin related work.

• &bull Lease with HR for on time & quality recruitment.

• &bull Track Project Performance Quality & Quantitative Metrics.

• &bull Ensure adherence to Quality norms and processes.

• &bull Adhere to security practices set by organization.

• &bull Maintain confidentiality of all information, policies, and procedures as required by the Health Insurance Portability and Accountability Act (HIPAA) protocols.

For Medical Management and RCM:

• &bull Oversee daily operations, processes to ensure that all quality and efficiency standards and targets are met.

• including but is not limited to daily completion rate, accuracy of data encoded in the review, attendance and adherence to company protocols.

• &bull Oversee the performance of new on boards and ensures coaching of the team.

• &bull Analyze areas for improvement for meeting program objectives and participates in establishing Quality Improvement Projects for the program.

• &bull Provide weekly coaching to the team in relation to their scope of work.

• &bull Cascade essential information and updates to team through the weekly meetings.

• &bull Provide regular and periodic feedback to the Program Manager on the team performance for coaching and appraisal purposes.

• &bull Ensure that immediate supervisors are appraised on significant program activities, issues and concerns through emails, meetings and weekly reports.

• &bull Handle staff questions and escalation as necessary.

• &bull Perform senior process executive functions as needed.

• &bull Supervise the hiring process.

• &bull Review all QC and QA reports and reinforce corrections and suggestions made the quality reviews team.

• &bull Collaborate with the team and clients and assists the Operations manager with managerial activities as needed.

• &bull Reward and discipline employees.

• address complaints and resolve problems.

• &bull Coach and develop Nurse Reviewers, Administrative Staff, Subject Matter Experts (SME), and Team Lead to promote an understanding of the company culture, policies, goals and procedures.

For Claims, NA, RCM and Member Services:

• &bull Support Knowledge transfer at the time of process transition from the business site.

• &bull Drive team to achieve process Service Level Agreements / metrics ie productivity and quality targets within the established timelines.

• &bull Ensure compliance controls are met.

• &bull Ensure documented process guidelines are followed.

• conduct periodical reviews for process adherence.

• &bull Conduct adhoc Quality checks.

• &bull Review process audit findings and take corrective action.

• &bull Innovate ideas to error proof the process & reduce manual interventions.

• &bull Conduct process training or refresher trainings, if required.

• &bull Maintain operations rigor around daily huddles, visual management, knowledge management, cross training etc.

• &bull Initiate and deliver on process improvement projects to improve process efficiencies.

• &bull Provide updates and submit reports related to own area of work.

• &bull Ensure optimum resource utilization through cross training initiatives and buffer management.

• &bull Interface with other departments for getting required assistance or support for the team.

• &bull Engage with other processes to understand and implement best practices.

• &bull Lead calibration initiatives with the client and for the team.

• &bull Drive a culture of continuous improvement within the team.

For NA:

• &bull Provide updates and submit reports related to own area of work.

• &bull Is the escalation contact for clients and internal stakeholders.

• &bull Ensure all data update requests are tracked and status updates provided to management.

• &bull Plan resource rotation to comply with Organization / Business Unit recommended Pyramid and Span.

• &bull Manages project risks and issues, ensuring that project team members are actively involved in the identification and where appropriate the ownership of risks, initiating corrective action where necessary.

For NA TM Only:

• &bull Follows customer profitability practices such as Cost optimization methods, productivity & quality benchmarking, periodic target revision etc.

• &bull Ensure tracking and collating of Quality (internal, external & client facing) data is performed accurately through BPS Quality Report.

• &bull Participate and provide inputs during Solution development activities Build relationships with line managers or portfolio owners in the customer organization.

• &bull Share best practices with the Organization and leverage Organization assets for the benefit of the project.

• &bull Establishes the key calendar of events for the project / LOB.

• &bull Identify and highlight areas of risk in the process.

People / Team:

• &bull Ensure appropriate distribution of work among direct reports.

• &bull Responsible for creation and implementation of learning plans and skill upgrade.

• &bull Responsible for Performance management and career development of the team members.

• &bull Encourage Team to contribute and participate in training programs.

For Medical Management, RCM and Provider Services:

• &bull Ensure completion of training plan for all direct reports.

• &bull Responsible for driving Reward & Recognition and employee engagement.

For NA, Claims, RCM, Provider Services and Member Services:

• &bull Guide and mentor team members.

• &bull Groom self and team to support vertical/business growth.

• &bull Conduct team building activities to enhance motivation.

• &bull Conduct regular 101s to gauge the pulse of the team members.

• &bull Complete mandatory training for self as identified in the training plan for the project.

• &bull Review VOC scores, provides feedback and recommend refresher training whenever necessary.

• &bull Report to the manager on per.