Supv, Out of Network Mandate

Horizon Healthcare Services•Newark, NJ

13d•Onsite

About The Position

This position is responsible for providing oversight for the State and Federal Out of Network (OON) Mandate program(s). The position supports the development and implementation of standards, systems, policies, and procedures in alignment with organizational strategic initiatives, ensuring compliance with all State, Federal and Association mandates pertaining to out of network payment rules (i.e. Out of-Network Consumer Protection, Transparency, Cost Containment and Accountability Act (OON Mandate).

Requirements

High School Diploma/GED required.
Requires a minimum of three to five years experience in a professional business environment.
Requires three to five years experience medical claims processing.
Require of extensive knowledge of computers and software relative to the business and extensive knowledge of functional tasks performed within the team.
Require general knowledge of tasks performed by areas that support the business team.
Require knowledge of medical and/or health insurance industry.
Require the ability to express thought clearly and concisely both orally and in writing.
Require the ability to obtain the skills possessed by the team members and to demonstrate technical competence on systems used.
Require the ability to effectively lead team members in diversified tasks.
Requires excellent organizational skills.
Requires excellent presentation skills.
Requires the ability to think analytically and to report findings in a accurate manner.

Nice To Haves

Bachelor degree preferred or relevant experience in lieu of degree.
Prefer three to five years experience as a supervisor.
Prefer three to five years experience in the health insurance industry.

Responsibilities

Supervises, analyzes and coordinates the work of the business team to ensure that quality and productivity goals are met.
Provides help, guidance, training, technical training and instructions to staff so that team members can improve their performance and broaden their skill sets.
When necessary, performs the operational duties of the business team members.
Ensures an atmosphere within the business team which fosters open communication, teamwork, participation, ownership, and empowerment to make decisions.
Evaluates the performance of the business team as a whole and of the individual members of the team.
Ensures that the customer is satisfied with the level of service provided.
Acts as technical expert and reference point for difficult and complex matters.
Facilitates the creation of service and processing innovations within the team.
Shares innovations with other teams and market divisions.
Monitors and reports on key performance indicators to team members and to upper management.
Assists in preparing and monitoring the budget to ensure administrative cost objectives are met.
Identifies and implements cost saving/revenue generating opportunities.
Interfaces with other teams and plan areas to assure consistent application of policies and procedures and to facilitate inter-unit/department projects.
Interprets and executes and modifies policies for the business team.
Participates in special projects initiated by the Plan.
Represents the Plan with external customers, providers and external agencies.
Develop/Update enterprise-wide training material related to OON Mandate Surprise Billing handling.
Represent Surprise billing functions on divisional and enterprise work groups.
May be responsible to lead some such groups.
Maintains a motivated and productive staff by providing sound leadership and direction; models appropriate behavior; renders timely decisions; provides coaching, feedback and recognition; conducts appropriate and timely performance appraisals; selects the best qualified candidates to fill job vacancies; administers company policies fairly; provides for development activities and opportunities to assure the application and assessment of skills learned.
Manages departmental administration expenses, including salary and non-salary costs, within the established budgetary constraints.