This position will provide leadership and direction to staff and vendors to ensure that all bill review programs fully support PMSI’s strategic goals and initiatives and enable PMSI’s competitive advantage. This position will have responsibility for planning and implementing internalized and vendor Bill Review programs and the management of a team of PMSI specialty bill review staff across multiple lines of business.
Basic Functions:
· Develops, negotiates and implements vendor management programs/relationships in accordance with PMSI strategic business and service plans.
· Develops policies, procedures and efficient and effective workflows to support the bill review programs.
· Produces results (both financial and customer outcomes) by developing , implementing and managing these programs.
· Selects, hire, manage, train and develop specialty bill review staff including conducting formal and informal performance appraisals, coaching and corrective counseling when necessary.
· Establishes and oversees service performance and quality standards/metrics.
· Analyze and troubleshoot system needs and work with IT to design and implement enhancements.
· Works with account management as the management liaison to investigate and resolve customer bill review inquiries and complaints.
· Assists sales team with completion of bill review questions in RFPs and/or prospect presentations.
· Assists in planning for and allocating department resources; assist with management of department budget and expenses.
· Provides company technical guidance, direction and training on bill review.
· Keeps up with bill review industry trends and legislative changes to enable PMSI competitive advantage.
Competencies:
· Analytical Skills – Ability to analyze and synthesize information to understand issues and identify options.
· Business Financial Knowledge – Ability to apply technical and professional knowledge to improve the effectiveness and profitability of the company.
· Critical Thinking – Ability to use logic and reasoning to identify the strengths and weaknesses of alternative solutions, conclusions or approaches to problems.
· Evaluating and Deploying People accurately – Ability to read people accurately; can diagnose strengths, weaknesses, and potential; knows what skills are required to fill a job or role; hires the best.
· Understanding the Business – Ability to know the business and the mission-critical technical and functional skills needed to do the job; understands various types of business propositions and understands how businesses operate in general; learns new methods and technologies easily. Understands the organization’s business model and competitive position in the marketplace. Understands potential for growth and profitability.
· Making Complex Decisions – Ability to solve even the toughest and most complex of problems; great at gleaning meaning from whatever data is available; is a quick study of the new and different; adds personal wisdom and experience to come to the best conclusion and solution, given the situation; uses multiple problem-solving tools and techniques.
· Managing Diverse Relationships – Ability to relate well to a wide variety of diverse styles of people, types, and classes; open to differences; effective up, down, sideways, inside, and outside; builds diverse networks; quick to find common ground; treats differences fairly and equitably; treats everyone as a preferred customer.
· Organizational Skills – Ability to multitask and manage multiple projects
· Flexibility – Ability to work in a fast paced environment.
· Computer skills – Possesses intermediate to advanced Microsoft Suite Knowledge (Word, Excel, PowerPoint).
· Communicating Effectively – Ability to write and present effectively; adjusts to fit the audience and the message; strongly gets a message across.
· Detailed Oriented – Ability to be well organized and resourceful, has the ability to reduce a complex concept or task into something that is manageable and clearly interpreted. is able to get things done with less and in less time; can work on multiple tasks at once without losing track; foresees and plans around obstacles.
· Team player – Ability to manage strong working relationships within the company. Able to complete tasks and work cooperatively with others.
· Adaptability - Ability to respond and adapt to changing circumstances and to manage, solve problems and provide solutions in a climate of ambiguity.
· Motivating & Delegating – Ability to manage people well; gets the most and best out of the people he/she has; sets and communicates guiding goals; measures accomplishments, holds people accountable, and gives useful feedback; delegates and develops; keeps people informed; provides coaching for today and for the future.
· Attracting and Developing Talent – Ability to attract high caliber people; Develop teams and talent with diverse capabilities; accurately appraise the strengths and weaknesses of others; provide constructive feedback; Develop successors and talent pools.
Job Qualifications:
Education
Required: Bachelors Degree in Business Administration/Management. Desired: Masters Degree in Business Administration or Management
Work Experience
Required: 3+ years of Workers’ Compensation Medical Bill Review and Bill Review Applications, 5+ years of experience in a Supervisory/Management role, and Prior experience working collaboratively with cross-functional business units to implement programs/applications.
Desired: 5+ years of Workers’ Compensation Medical Bill Review and Bill Review Applications
Licenses/Certifications:
· Required:
· Desired:
Work Environment:
The work environment characteristics described here are representative of those an associate encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. The noise level in the work environment is generally quiet to moderate.
Physical and mental requirements:
The physical demands described here are representative of those that must be met by an associate to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions:
1. Sedentary physical activity requiring reaching, sifting, lifting, finger dexterity, grasping, feeling , repetitive motions, talking and hearing.
2. Visual requirement is for close vision, distance, vision, peripheral vision and ability to adjust focus.
3. 50% or more time is spent looking directly at a computer.
4. Associate is frequently required to stand, walk (or otherwise be mobile).
5. Ability to deal with stressful situations as they arise.
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