Job ID: 10021

  • Nov 16, 2020
  • Picadilly Star - Bonifacio Global City

The Claim Review Operations Manager (DRG Validation) will be responsible for managing teams of Operations/Coding support as well as Clinical RN/Audit support. This position will serve as a Manager for Payment Accuracy teams and will direct and support the day to day activities of assigned staff, provide accurate and timely resolution for lines of business and work closely with US Payment Accuracy Solution teams. The manager will act with expertise using clear and effective verbal and written communication skills, request actions or resolutions and execute plans and policies. The Manager will lead Operations and Clinical analyst, build strong stakeholder relationships collaborating with the Business to accomplish goals and objectives. 

Primary Duties/Responsibility 

1: Will manage a team of individuals to ensure deadlines are met, workload is effectively balanced and production levels are achieved. Training of staff on applicable operating procedures. Provide complete, accurate and timely responses to stakeholder and leadership. Provide support and guidance for staff and encourage engagement. 35% Primary Duties/Responsibility 

2: Assess processes metrics and identifies opportunities to improve. Recommends and creates additional metrics to better assess the health of our people, process and tools. 35% Primary Duties/Responsibility 

3: Assess operating processes and identifies opportunities to improve. Ensure adherence to established standard operating procedures. Ensure compliance with HIPAA and other regulatory requirements. 30% Communication of daily metrics, issue and gap analysis and overall risk impacts that impede our ability to recognize revenue associated with the inventory they are assigned. This job is well defined as it relates to the day to operational expectations but will require the candidate to perform root cause analysis on issues that impede our ability to perform the work as directed. These are new roles to the team and the Manager will be responsible for any process improvement, tools or resource structures. Creating strategy and culture in relation to Org design and team functionality ensuring appropriate resources and support. 

 This role will require the candidate to understand the impact of gaps identified, quality errors and performance concerns. As it relates to personnel decisions, they will work with HRBP/ER on a plan of action. Process efficiencies or enhancements will ultimately be solutioned collaboratively between this role and senior leadership.

Ability to mentor team members with a variety of learning styles. Ability to build relationships and motivate cross functional teams to achieve results in a self-empowered environment. Excellent analytical, organizational, and prioritization skills.

MicroSourcing offers diversity in career options. We welcome individuality in self-expression without losing the value for team involvement. We are a fresh look at the BPO & KPO industry. Come experience the MicroSourcing life and be part of our growing family.

Cultures and Values

We are a fast growing company but we have always been able to keep the fun, young and intimate atmosphere from the time we started. We strongly believe in transparency and honesty and we always make sure to represent the interests of our employees as much as we represent the interests of our clients.

  • Work Hours: Night Shift - 9:00PM to 6:00AM