Job Description - Manager, Operations Support Services in Camarillo
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Manager, Operations Support Services

Ref: US_EN_6_914737_1335924

Posted yesterday
Job Location
Camarillo, California
Contract Type
Permanent
Category
Health Care

At Modis, we use our insight, knowledge and global resources to make exceptional connections every day. With 60 branch offices located strategically throughout North America, we are positioned perfectly to deliver the industry's top talent to each of our clients. Clients choose Modis as their workforce partner to solve staffing challenges that range from locating hard-to-find niche talent to completing quick-fill demands. Position:  Operations Support Services Manager

Direct Hire

Salary:  DOE/Market Location:  Camarillo, CA

Modis Burbank is looking for an Operations Support Services Manager for a great client in the Ventura County area.  The Operations Support Services Manager, in collaboration with the Director of Operations, is responsible for a variety of activities that support the Operations Department including, but not limited to, management of the encounter data process, Operations reporting, fee schedule oversight, Delegation Oversight audit support, cost containment activities and various financial data requests.

ESSENTIAL FUNCTIONS

  • Adhere to regulatory and internal guidelines in conjunction with Company policies and procedures as they apply to both internal and external encounters reporting.
  • Ensure timely submission of encounter data files from external entities.
  • Perform data analysis of submitted encounter data to ensure accuracy and completeness of submitted data.
  • Work with external entities to correct unacceptable data prior to re-submission to Company.
  • Ensure timely and accurate reporting of encounter data to the appropriate government agencies.
  • Support Finance staff in researching and analyzing IBNP trends.
  • Perform basic statistical analyses for projects and reports and prepare graphs, reports, and presentations of the results.
  • Extract and analyze data from various sources to achieve cost saving programs for the Plan.
  • Assist Compliance staff with Delegation Oversight audits as required.
  • Prepare internal and external routine and ad hoc reports for claims, encounters or membership related projects, both within the department as well as company-wide.
  • Work closely to improve EDI claims submission volume.
  • Identify cost containment opportunities including programs to reduce fraud, waste and abuse.
  • Maintain an up-to-date and thorough knowledge of company's policies and reporting requirements as related to eligibility, benefits and claims.
  • Provide accurate research to resolve issues regarding eligibility, benefits, claims and authorizations using appropriate systems.
  • Work collaboratively with Claims, IT, Configuration, Provider Network Management and Finance to proactively identify manual processes, potential problems, and risk areas and seek automated solutions.
  • Develop action plans and implement activities that will mitigate negative impacts and enhance positive changes to the organization.
  • Manage, select, evaluate, train, lead and direct staff in support of strategic and business efforts; build an effective team and assist in ensuring appropriate staffing and staff development.
  • Ensure the organization and its mission, programs, products, and services are consistently presented in a strong, positive image to relevant stakeholders.
  • Perform other duties as assigned.

SKILLS & ABILITIES

Education: Bachelor's Degree (four year college or technical school) Required, Field of Study: Health Care Administration, Business Administration, Health Care Economics, or related field.

Experience:   5 plus years of experience in managed care environment, or one that would have developed the knowledge and abilities above. Supervisory experience in a health care environment. Computer Skills: Advanced computer skills included in the MS Office products.

Other Requirements: Knowledge of:

  • Principles and practices of managed health care, Medi-Cal claims processing, eligibility and benefits.
  • Medical billing/coding (ICD-9 and ICD-10); COB/TPL regulations and guidelines.
  • Claims operations, cost containment activities and supporting information systems

o    Principles and techniques of administration, organization, and management including an understanding of the key issues that exist in the health care industry.

o    Principles, practices, techniques, and theories of management and supervision, including selecting, training, delegating, advising, mentoring, evaluating, and disciplining employees.

o    State and federal laws, ordinances, regulations, codes, precedents, government regulations, and agency rules, as they relate to managed care, Medicaid and other related business and policies governing managed care issues.

If interested, please apply immediately or email your resume to dwijen.mehta@modis.com.  

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