RN Clinical Provider Post Service Review Manager
1 day ago
Blue Cross Blue Shield of Massachusetts is seeking a highly skilled RN Clinical Provider Post Service Review Manager to join our team. As a key member of our organization, you will be responsible for leading a team of provider correspondence associates who research and respond to provider inquiries and appeals, build cases, and perform claim adjustments in a dual system environment.
Key Responsibilities- Lead and motivate a team of provider correspondence associates to achieve high levels of performance and continuous improvement.
- Develop and implement strategies to improve team productivity and efficiency.
- Collaborate with cross-functional teams to ensure compliance with regulatory requirements and identify opportunities for process improvements.
- Provide direct oversight to meet/exceed key performance metrics.
- Manage performance and productivity, and offer day-to-day support to team members.
- Understand and operationalize the rules and regulations set forth by FEP, NCQA, and ACA.
- Provide timely feedback and ongoing coaching and mentoring for all associates.
- Support clinical and administrative processes outlined by regulations.
- Active professional Registered Nurse in MA required.
- 4+ years of experience in a management level position/operational leadership experience preferred.
- FEP (Federal Employee Program) and/or experience working within a regulatory space preferred.
- Ability to demonstrate proficiency with multiple Information Technology systems.
- Working knowledge of claims systems is a plus.
- FEPDirect experience a plus.
We understand that the confidence gap and imposter syndrome can prevent amazing candidates from coming our way, so please don't hesitate to apply. We'd love to hear from you. You might be just what we need for this role or possibly another one at Blue Cross Blue Shield of Massachusetts. The more voices we have represented and amplified in our business, the more we will all thrive, contribute, and be brilliant. We encourage you to bring us your true colors, your perspectives, and your experiences. It's in our differences that we will remain relentless in our pursuit to transform healthcare for ALL.
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