Role Description



A manager should be able to manage all operations for a process / client depending upon the size of the engagement (typical span: 50-80 associates)

meet SLAs while independently drive operational efficiency

Outcomes

Works closely with the Manager/Group Manager to achieve quantitative and qualitative SLAs and KPIs for the team

Focuses on planning and execution to ensure quality improvement turnaround time and overall process efficiency

Identifies process gaps and collaborates with the client to formulate solutions for the same

Regularly interacts with the Quality team to ensure real time action in cases of quality defects

Leads corrective and preventive action plans for various transactions and owns them

Ensures that leads are informed on all process and business updates; and the relevant information is cascaded to associates in every team to ensure transparent communication

Set clear team goals and transparent objectives on what the team is working towards to ensure clarity

Measures Of Outcomes

100% Adherence to quality standards process and SLAs

Number of issues resolved and tasks completed

Number of non-compliance issues with respect to SOP

Zero/No Client Escalations

Percent of completion of all mandatory training requirements

Percent of QC and QA scores

RCA and Corrective Action Plans

Daily/weekly performance reporting

Number of high-quality RCA and QA output

Guides and mentors the junior associates

Swift turnaround time for response and resolution

Update SOPs and job aids on a weekly basis

Delegate tasks and set deadlines for the team

Operations

Outputs Expected:

Ensure team handles the work received and adheres to SLAs

Quality

Responsible for creating quality plans and implementing quality management function

Communication

Responsible for reporting and communicating with client and internal team members

Communicates with clients daily and provides status update obtains feedback and acts immediately on any issues highlighted

Provides status update to the respective stakeholders and within the team

Shares performance reports to the client at the end of every month on team output and productivity

Process/efficiency Improvement

Proactively identify opportunities to increase service levels and mitigate any issues in delivery within the function or across functions

Take accountability for overall productivity efforts within the function including coordination of function specific tasks

Training

On time completion of all mandatory training requirements of organization and customer

Provide on floor training and one on one mentorship for new joiners

Complete certification of respective career paths

Performance Management

Update FAST Goals in NorthStar track report and seek continuous feedback from peers and manager

Set goals for team members and mentees and provide feedback

Escalation

Escalate problems to appropriate individuals/support team based on established guidelines and procedures

Monitoring

Monitors progress of requests for support and ensures users and other interested parties are kept informed

Process Adherence

Thorough understanding of organization and customer defined process

Consult with mentor when in doubt

Adherence to defined processes

Adhere to organization s policies and business conduct

Manage Knowledge

Consume project related documents share point libraries and client universities

Issue Resolution

Identifies analyses and solves the incidents/transactions

Perform root cause analysis to find corrective and preventive actions after every major incident and escalations

Work closely with team members to solve customer problems

Understand agent's problems and weaknesses and address

Release

Adhere to release management process

Team Management

Set expectations; manage performance of team and individuals

Provide regular feedback

Coach team towards operational excellence

Recognize high performing talents in the team and reward them

Mentoring

Guide new team members in understanding customer infrastructure and processes

Mentoring and providing guidance to the peers and junior associates

Assist new team members to understand the customer environment

Management

Able to make decisions on any matters relating to improving revenue generation and customer satisfaction with regards to call handling and call center processes

Skill Examples

Customer Focus: Focus on providing a prompt and efficient service to customers; goes out of the way to ensure that individual customer needs are met

Attention to detail to ensure metrics quality and production output and reporting is accurate

Team Work: Respect others and work well within the team

Communication: Speak clearly and write in a clear and concise manner

Uses appropriate style and language for communication (Data)

Communication: Speaks in an accent neutral manner or with the accent required for the process with good vocabulary and grammar skills

Writes clearly (Voice)

Analysis and Decision Making: Makes judicious and fair decisions after examining all relevant information and making clear assumptions

Team Coaching and Leadership: Lead the team by example

Guide and support the team towards the achievement of goals

Coaches and guides leads in managing outcomes and expectations well

Manage and facilitate aspirations and skill development for team

Proactive in avoiding or resolving conflicts

Planning skills: Translate business objectives into functional activities

Set goals and processes and organize resources to ensure that the desired results are met

Excellent communication and leadership skills

Organizational and time management skills

Assistant Manager Operations Training Quality MIS Process Excellence

Leadership role with span of up to 60 FTE

Knowledge Examples

Familiar with Windows Operating Systems MS Office

Excellent English comprehension reading writing and speaking

Domain knowledge based on process (healthcare banking investment F&A retail customer support etc)

Expertise with process knowledge and guidelines

Expertise in work allocation and intake functions

Expertise in MS Excel

Expertise with quality control processes including pare to analysis and root cause analysis

Typing speed with 15WPM and 80% accuracy Voice

Typing speed with 30WPM and 95% accuracy Data

Experience level 9 to 12 years

Additional Comments

Manager, Provider Credentialing About UST HealthProof At UST HealthProof, you will join a fast paced, growing company in our mission to reshape the future of health insurance through significantly reducing administrative costs and building better healthcare experiences for our health plans customers and their members

By creating a modern, cloud based, Best-In-Class core administration ecosystem, we have made healthcare more affordable and helped our health plans operate more efficiently

Through member and provider touchpoints with less friction, we have created real impact for members

UST HealthProof is run by leaders with strong health plan and technology backgrounds who have start-up mindsets and an environment of support where individual growth is nurtured

You will be supporting our proven core admin solutions and business process-as-a-service (BPaaS) operations to provide transparency, improve operational efficiency, and break down operational barriers to scale and drive strategic growth

UST HealthProof is looking for Provider Credentialing Manager, reporting to the Director of Business Operations

The Credentialing Manager is responsible for a team of up to 12-15 credentialing specialists, extensive interaction with client organization, and multiple stakeholders

The Credentialing Manager is accountable for delivering a high-quality credentialing operation, exceeding all service level agreements and KPIs, driving operational excellence, and building competencies for delivery

As a Provider Credentialing Manager at UST HealthProof, this is your opportunity to

Be responsible for directly managing a staff of up to 12 15 associates

Manage the workflow for staff that process provider credentialing and recredentialing applications for medical providers

Implement policies & procedures to ensure applications are properly verified and accurately uploaded into a credentialing database system

Ensure credentialing applications are tracked and monitored for adherence to timelines and quality standards

Analyze and prepares reports on results of the Credentialing Verification Organization in the application status

Conduct training sessions for staff members on new policies or procedures, as well as ongoing training to ensure that associates are familiar with protocols

Provide coaching and upskilling to staff members depending on quality results

Make recommendations on improvements to the credentialing and recredentialing policies and procedures, based on experiences and/or evolving regulatory requirements

Identify training and development needs You bring:

7+ years Credentialing experience in progressively more responsible positions

Minimum of 3 years of Credentialing management experience

Strong understanding of credentialing databases/systems, Santech preferred

Associate degree in related health care field, or commensurate experience

Ability to effectively lead a credentialing team

Excellent communication skills (verbal and written)

Willingness to learn new skills

Team collaborator

Strong work ethic For this role, we value:

The ability to adapt quickly to a fast-paced environment

A self-starter and quick learner

Team player with an ability to collaborate

Ability to coach the team to reach their full potential

Skills

Healthcare,Provider Enrollment , Credentialing , Contract Management

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Key Skills