The Sr. Operations Manager ensures the quality of payment policy configuration so that its application to claim data is consistent and compliant with the intent of the policy. This Sr. Manager is also responsible for driving down production errors, improving what we do and how we do our work through people, processes and applications; meeting and exceeding the expectations of our internal and external customers; and, empowering our teams for performance excellence.


Responsibilities
:

  • Provides direction to the onshore operations team to achieve company quality goals.
  • Ensures all functions are performed on schedule to ensure a timely system release.
  • Completes work orders for each monthly release by the established cut-off dates.
  • Completes schedule of cleanup and improvement projects.
  • Consults internally on late or emergency work orders ICMS rule changes unit and regression testing (RMRs).
  • Client implementation rules testing and support.
  • Develops departmental procedures and processes to continuously improve the performance of
    operations.
  • Develops staffs interdepartmental, business and industry knowledge to enhance sensitivity and awareness of their impact to the overall product, company success, and client satisfaction.
  • Participates in and supports organizational product development and process improvement teams to improve product delivery and quality.
  • Drives the enhanced level of expertise across the staff through continuous training and exposure to other departmental processes and products.
  • Reduces the overall rate of production errors.
  • Develops and executes processes to audit work product. Identifies the root cause of errors and feeds them into a process for improvement.
  • Incorporates feedback from other business units and Client Services.
  • Adds value through vigorous participation on process improvement teams and execution of action
    items.
  • Effectively implements and applies Cotiviti’s Talent Management methodology to develop and manage a high performing team.
  • Establishes a strong operational foundation for the department.
  • Develops and implements processes that result in improved performance.
  • Defines assignments clearly and with deadlines, expectations and metrics.
  • Reports on progress to plan regularly.
  • Develops and implements creative solutions that eliminate barriers to attainment of our core Values in Action.
  • Impacts Performance Excellence and Continuous Improvement with vigorous participation on Process Committees.
  • Executes user-acceptance testing plans.
  • Builds internal relationships with other departments and serves as an advocate for Medical Policy. Responds to emergent needs (i.e. putting out fires).
  • Ensure complete and accurate turn around on inquiries received by the Inquiry Team

  • Ensure complete and accurate configuration for all implementation projects undertaken by Integrations

  • Participate and completes external Company audits, ie: SOC, HiTrust, Information Governance, etc.


Requirements
:

  • Bachelor’s degree preferred or equivalent experience.
  • Coding Certification (CPC, CCS, etc.) preferred.
  • 2 years of claims operations, provider billing or claims systems testing/development.
  • 2 years of management experience (manager level or higher).
  • Experience with testing process development and improvement.
  • Experience with automated testing, regression testing and performance testing.
  • Experience in process definition and continuous quality improvement.
  • Flexibility in thought and approach to problem solving.
  • Ability to understand process inputs/outputs and effects of all.
  • Strong understanding of system or product development lifecycle.
  • Strong claims testing, processing and/or provider billing knowledge.
  • Strong and demonstrated belief in excellent product quality and client satisfaction.
  • Ability to quickly learn companies capabilities, requirements and limitations.
  • Ability to manage a cross-functional team in a matrixed environment.
  • Builds credibility and establishes influence with internal team members and client team
    members in a way that leads individuals to solicit and follow advice or direction.
  • Strong focus on detail, root-cause analysis, and change management.
  • Strong knowledge and capability for process improvement, process management, and measurement.
  • Demonstrated experience and capability of organizational skills, sound judgment and decision making, people management, and results focus.
  • Proficient with Microsoft Office Suite (Word, Excel, Power Point).
  • Excellent written and verbal communication skills.


Work Environment:

  • This role will ultimately work from our Atlanta office but is currently working remote. Access to high speed internet is required (all other equipment will be provided).
  • Must be able to sit and use a computer keyboard for extended periods of time
  • Must have flexibility and willingness to participate in the work processes of an international organization, including conference calls scheduled to accommodate global time zones.
  • Flexibility in reference to work schedule.
  • Must have ability to positively handle/manage stress, such as high work volume and frequent change.
  • For the safety of our employees and those considering employment with Cotiviti, we are currently conducting all interviews virtually. In addition, the majority of the Cotiviti team is currently working remotely, and we are onboarding new hires remotely as well. As we monitor the pandemic, these arrangements may change and we will update accordingly.

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Equal Opportunity Employer/Protected Veterans/Individuals with Disabilities

The contractor will not discharge or in any other manner discriminate against employees or applicants because they have inquired about, discussed, or disclosed their own pay or the pay of another employee or applicant. However, employees who have access to the compensation information of other employees or applicants as a part of their essential job functions cannot disclose the pay of other employees or applicants to individuals who do not otherwise have access to compensation information, unless the disclosure is (a) in response to a formal complaint or charge, (b) in furtherance of an investigation, proceeding, hearing, or action, including an investigation conducted by the employer, or (c) consistent with the contractor’s legal duty to furnish information. 41 CFR 60-1.35(c)