What are the responsibilities and job description for the OPERATIONS LEAD position at Aultman Health Foundation?
PURPOSE OF POSITION:
The primary purpose of the Operations Lead is to oversee key processes within their assigned department. Must be able to perform all duties of the Claims Analyst III and/or Service Representative III. Depending on the structure of the department duties may vary.
RESPONSIBILITIES & EXPECTIONS:
- Reviews and monitors department quality and productivity indicators and implements action plans to ensure compliance with the organization’s goals.
- Trains and Mentors employees of the department.
- Coordinates processing and resolution of grievances and appeals
- Represent unit in meetings regarding policies and procedures, sharing staff concerns and seeking resolution.
- Researches and analyzes data to address operational challenges and customer service issues
- Responsibilities may include, Kronos timekeeping, performance reviews, disciplinary actions as warranted.
- Serves as a resource for other department inquiring about claims.
- Supervises staff or processes such as quality control for the unit.
- Takes escalated calls requiring Supervisory intervention.
- Oversees unit scheduling
- Covers for Supervisor/Manager in their absence.
- Assists/supervises process flow of the department such as claim inventory and workflow, difficult recalc projects, large dollar claim reviews and/or coordinate refund inventory
- Demonstrates understanding of the application of benefit contracts, pricing, processing, policies, procedures, government regulations, coordination of benefits and healthcare terminology.
- Displays excellent knowledge of the various operations of the organization, products, and services.
- Displays good work habits and organizational skills by working in date order and prioritizing daily work flow; i.e., claims, referrals, questions, and possibly special projects.
- Displays a positive attitude and willingness to work as a team.
- Process Improvement: Continuously reviews, recommends and implements improvement steps, as needed or directed.
- Seeks supervisory guidance/approval as appropriate.
- Portrays professional image: follows dress code, communicates with internal and external customers in a professional manner, including appropriate verbal and written grammar.
- Promotes and demonstrates professional standards to enhance the development of the department.
- Practices ethical conduct.
- Meets acceptable attendance and punctuality expectations (excluding FMLA)
The above statements reflect the general duties considered necessary to describe the principle functions of the job as identified, and shall not be considered as a detailed description of all the work requirements that may be inherent to this position.
All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, gender identity, sexual orientation, age, national origin, disability, or protected veteran status. AultCare is an EEO/AA Employer M/F/Disability/Vet.
QUALIFICATIONS:
- Education: Associate’s degree preferred, high school diploma or GED required.
- Minimum three years’ AultCare experience for a health insurance plan.
- Able to type a minimum of 40 wpm.
- Expert level knowledge of HMO, PPO and Medicare plans/benefits.
- Expert level knowledge of medical terminology.
- Knowledge of ICD10 Coding.
- Mastery of Microsoft Word, Excel and Outlook.
- Available to work 40 hours per week anytime within the operating hours of the department, Monday through Friday, 6:00am-8:00pm, which may include weekends and holidays.
WORKING CONDITIONS
- Frequent sitting, use of hands/fingers across keyboard or mouse, and long periods working at a computer.
- Office environment with minimal noise level due to computers, printers and floor activity.
- Frequent walking and bending to assist staff within workstations.
