Supervisor Medical Management Intake Operations

3 weeks ago

Eagan, United States Blue Cross and Blue Shield of Minnesota Full time
About Blue Cross

Blue Cross and Blue Shield of Minnesota is one of the most recognized and trusted health care brands in the world with 2.5 million members. We’re committed to reinventing health care to improve health for our members and the community. We hope you'll join us.

How Is This Role Important to Our Work?

This position provides an advanced level of supervisory leadership and work direction within the Medical Management. Shared Services intake operations/support department. This position is able to lead day-to-day support operations when required. This position is responsible for supervising the activities of a large, diverse, multi-focused workforce supporting all lines of business. Work involves supervising integrated Case Management and Utilization Management support staff as an extension of the clinical review processes and programs within Medical Management. This position is responsible for ensuring appropriate work flows within the department are followed based on established policies and procedures and performs designated staff audits to ensure work accuracy. This position supervises support staff engaged in telephonic requests, prior authorization and preadmission notification requests, case management referrals, claims/adjustment requests, transplant coordination, and various trigger mechanisms (ex., high dollar claim triggers). This position will support the objectives of the Integrated Health Management teams and provide assistance to team members in accomplishing their individual objectives. Provides oversight and work direction to staff on Medical Management medical record management activities.
A Day in the Life:

  • Supervises the department including interviewing and hiring employees following required EEO and Affirmative Action guidelines and ensuring employees receive the proper training.
  • Conducts performance evaluation, and is responsible for managing employees, including skill and career development, policy administration, coaching on performance management and behavior, employee relations and cost control.
  • Manages the allocation of resources including staff and technology to meet Medical Management objectives.
  • Provides support, training and scheduling of meetings and work direction to the Medical Management Shared Services Intake Operations team.
  • Supervises support staff and technical specialist staff to assure work is conducted in accordance with regulatory and HIPAA compliance requirements.
  • Performs designated staff audits and applies staff audit results by developing CQI objectives for the team.
  • Participates in the evaluation and implementation of continuous process improvement efforts and makes recommendations for improvements to enhance the Medical Management Shared Services Intake Operations support processes.
  • Assesses service issues and recommends solutions, collaborates with other areas to implement process improvements, and ensures contractual and regulatory compliance.
  • Monitors performance information (metrics, inventory, complaints, etc.) and ensures adherence to performance standards, certifies various levels of competence and achievement, and provides appropriate supplies and tools for professional development.
  • May also develop new audit mechanisms.
  • Participates in internal work-groups that affect Integrated Health Management work flows/requirements.
  • Provides oversight and work direction to staff on medical records management to ensure compliance with corporate medical record retention policies and practices and ensures Medical Management. customer needs are met.
    Nice to Have:
    • Bachelors degree preferred or equivalent work experience.
    • Working knowledge of medical and behavioral health terminology.

      Required Skills and Experiences:

      • 3+ years of related professional experience. All relevant experience including work, education, transferable skills, and military experience will be considered.
      • Strong, demonstrated ability to effectively lead a large team.
      • Extensive knowledge of health management service operations and systems, member and provider contracts/benefits, and regulatory and compliance requirements from a state and federal level.
      • Demonstrated, effective leadership skills.
      • Proven delegation skills.
      • Strong organizational skills.
      • Strong analytic and independent decision making skills.
      • Well-developed communication skills with ability to write clear, concise, and grammatically correct materials.
      • Knowledge of organization and ability to problem solve within the organization.
      • Comprehensive knowledge of health insurance system operations and commands.
      • Knowledge and ability to work in MS Excel, Word, Visio, and a centralized phone system (call center environment).
      • Demonstrated experience providing work direction and collaborating with others to ensure success.
      • The ability to relate technical issues in terms of impact to business operations is a key success factor.Make A Difference

        Blue Cross is an Equal Opportunity and Affirmative Action employer that values diversity. All qualified applicants will receive consideration for employment without regard to, and will not be discriminated against based on race, color, creed, religion, sex, national origin, genetic information, marital status, status with regard to public assistance, disability, age, veteran status, sexual orientation, gender identity, gender expression, or any other legally protected characteristic.

        Reasonable Accommodation for Job Seekers with a Disability: If you require reasonable accommodation in completing this application, interviewing, completing any pre-employment testing, or otherwise participating in the employee selection process, please direct your inquiries to talent.acquisition@bluecrossmn.com.

        All roles require a high school diploma (or equivalency) and legal authorization to work in the U.S.

        Blue Cross® and Blue Shield® of Minnesota and Blue Plus® are nonprofit independent licensees of the Blue Cross and Blue Shield Association.

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