Relationship and Implementation Manager
Responsible for liaising across departments, regarding all processes, communication and ensuring the operational part of the business is in compliance with the agreements. The position will also be accountable to manage the relationship with resources from the other areas of the organization within each initiative. The Relationship and Implementation Manager is required to have be an expert, and have full understanding of the Bupa Latin America suite of products and its operational administration and provide training as needed. The Manager assumes a proactive approach to delivering exceptional processes and standards that enable the delivery of excellent service and quality. Creates and develops a framework of how to anticipate and resolves issues. Identifies, communicates and resolves departmental and inter-departmental issues, concerns or complaints with a sense of urgency in order to ensure partner satisfaction. Represents the Medical Service Team in the relationship with third parties and reviews that established guidelines are followed.
The position is accountable directly or by direct supervision of:
- Represent the Medical Service Team processes and interests during Projects, Products Implementation, New regulationrioleouts, etc.
- The liaison for Integrated Networs and the USSC clinical support functions.
- Oversee the team responsible for the preauthorization of treatment for BINS (no latam) members, be it coming though the integrated networks or the USSC setup.
- Liaison with Mexico, DR and Miami MST teams for all matters concerning the various preauthorizations and medical services areas. Also serves as a liaison for the IT, Support Services team and other areas.
- Provides support, and training for associates, Managers, and others as needed.
- Documents processes and creates/updates manuals where appropriate including TPA guidelines.
- Monitors and evaluates trends, identifies potential areas that can cause errors during case’s evaluations/preauthorization, and makes recommendations to Management for changes or adjustments.
- Creates documentation of trends and logs processes/potential issues to share with Management Team.
- Actively participates and serves as an SME in projects or initiatives that are implemented in the department.
- Interacts with Team managers to assure consistency across the different policies
- Performs other related tasks as assigned.
- Integrate and interact with other areas of the business to ensure appropriate design and delivery of the new initiatives.
- Assist in decision making for important department implementations and procedures.
- Keep a knowledge base that can be used for the entire organization in future initiatives.
- Work in teams with other departments, especially with IT department, to coordinate actions and deliveries.
- Serves as the contact person and subject matter expert for all questions regarding medical billing and coding within the organization.
- Perform risk management and incident management activities.
- Identify training needs and ensure its delivery.
- Defines and documents the framework for managing a relationship within the Medical Services Team and other departments such as: Claims, Finance, Quality Control, Customer Service, Support Services, USSC and Provider Services (Health & Benefits).
- Coordinates with all areas of the business to identify, communicate and resolve issues related to medical services preauthorization process.
- Coordinates and conducts weekly meetings with Claims, IT, QC, and Provider Services and meets with other areas as needed.
- Attends escalated issues and resolves complex problems directly with the internal areas.
- Identifies training needs and/or process improvement opportunities.
- Acts as the change management lead for departmental changes and implementations.
- Delivers a structured and recurrent communication to the Claims Department to ensure alignment within the department and other internal areas, in regards to the nature of key updates and issues.
- Works closely with Medical Service Team Managers and Head of MST, to provide ongoing feedback.
- Visits DR and Mexico MST Department on an ongoing basis to provide feedback, training, and process improvements, and assessment of the preauthorization process.
- Documents all changes, progress and issues with relation to MST .
- Prepares and delivers training for any and all changes related to the Medical Service Team in Mexico,DR and Miami.
- Ensures that all department guidelines and objectives are met
- Provides assistance and support on issues/tasks as assigned
- Performs other related tasks as assigned.
The Ideal Candidate
- Medical graduate with at least five (5) years of experience in the medical or insurance field and at least two (2) year practicing medicine is required.
- Insurance or health care experience 2-3 years preferred.
- Minimum of 2-3 years’ experience in a customer service environment is required.
- Minimum 3 – 5 years of experience handling and resolving medical complex cases is required.
- Bilingual English / Spanish with the ability to write correspondence and verbally respond to inquiries and questions in both languages is required. Additional ability to communicate in other language is a plus.
- Must be available to travel up to 30%
- Knowledge of commonly-used insurance concepts, practices, and procedures is required
- Excellent communication skills
- Good analytical and problem-solving skills sufficient to identify issues and assess problems through resolution.
- Basic knowledge of MS Office suite including word., Outlook and Excel to create correspondence.
- Multi-cultural experience is preferred.
- Experience in a supervisory, management or leadership role within a team environment is preferred.
- Excellent customer service and sound interpersonal skills to appropriately handle escalated issues.
- Excellent organizational, time management, prioritizing and multitasking skills in order to mange team’s workload.
- Demonstrated initiative, flexibility and ability to embrace and drive change.
- Ability to work in a multi-ethnic and multi-cultural environment.
- 5 years of experience in the health insurance industry in Latin America with solid market knowledge of the health insurance industry in Latin America.
- Excellent interpersonal skills characterized by effective interactions with a diverse range of internal and external stakeholders and audiences.