Claims Editing Vendor and Management Strategist

UPMC•Pittsburgh, PA

5h•Hybrid

About The Position

UPMC Health Plan is hiring for a Full-Time Claims Editing Vendor and Management Strategist to work with our Claims Operations Coding department. The Claims Editing Vendor and Management Strategist is responsible for overseeing the coordination and administration of all aspects of Claim Editing and related vendor management the assigned claim editing team and any initiatives including but not limited to; planning, organizing, staffing, leading, and controlling program activities. Responsible for providing leadership direction and guidance to ensure a positive work culture, efficient project management, impact analysis & trends, issue resolution, as well as managing activities related to department objectives, goals, and initiatives impacting service level agreements, compliance, and client satisfaction. This position must develop and maintain a high performing and effective leadership team. The incumbent is responsible to direct activities to ensure compliance with code editing and achieving payment integrity related goals related to operational payment integrity goals established by senior leadership. This is a hybrid position. There is a once-a-week office requirement with additional time in office needed based on business needs.

Requirements

Bachelor's Degree preferred with analytical or healthcare focus or equivalent business experience of ten years.
6 years minimum management experience required with strong business acumen with emphasis on operational optimization, performance efficiency, continuous improvement, and financial performance, leveraging data analytics and business intelligence.
Effective communicator with the ability to listen, inspire and motivate; encourages collaboration and teamwork.
Ability to lead a team through ambiguity in a fast-paced, fluid work environment.
Demonstrated leadership skills to develop, plan, lead, implement, and execute issue resolution, strategic objectives/goals/initiatives across multiple functional areas, as well as external clients.
High degree of professionalism, enthusiasm, and initiative daily.
Manage multiple tasks and projects - with the ability to forge strong interpersonal relationships within the department, other departments, and with external audiences.
Ability to re-engineer or optimize to positively impact operations: processes, people, performance in terms of time, effort, accuracy, costs.
Experience leading a shared services organization is required.

Responsibilities

Maintains a positive work environment for staff with emphasis on the employee work experience. Responsible to recruit, develop, and motivate a high caliber staff to support departmental and organizational objectives.
Build a cohesive, professional, and self-directed team.
Ensure team provides service and support and compliance specific to code-editing and code updates according to the expectations of service level agreements; corporate/project deadlines; compliance and regulatory requirements.
Responsible for providing leadership direction to professional and management staff.
Initiate and set goals and new initiatives according to the strategic objectives of the organization and department ensuring all deadlines and milestones are met.
Develop evaluation strategies to improve efficiency, monitor performance ,and determine the need for improvements.
Develop and maintain positive working relationships with vendors to ensure accountability and optimal performance.
Assess situations to determine the importance, urgency, and risks to make clear decisions which are timely and in the best interests of the organization.
Interpret reports prepared by staff to determine progress and issues while keeping senior leadership informed with detailed and accurate reports or presentations.
Responsible for hiring, orientation and ongoing management of all assigned staff including but not limited to; conduct regular performance appraisals, provide constructive feedback, direction to improvement, provide positive leadership to all staff, encourage a team approach, professional attitude modeling best practices.
Work in tandem with other members of the health plan to advance the mission of the health plan and UPMC at large (medical management, quality, network, medical policy, pharmacy, etc.).
Establish and maintain positive working relationships with others, both internally and externally, to achieve the goals of the organization.
Develop new and unique methods to improve operations of the organization and to create new opportunities. Work cooperatively and effectively with others to set goals, resolve problems, and make decisions enhancing organizational effectiveness.