Job Description

Skill required:

Claims Appeals - Claims Administration

Designation:

Health Admin Services Manager

Qualifications:

Any Graduation

Years of Experience:

13 to 18 years

About Accenture

Accenture is a global professional services company with leading capabilities in digital, cloud and security.Combining unmatched experience and specialized skills across more than 40 industries, we offer Strategy and Consulting, Technology and Operations services, and Accenture Song-- all powered by the world's largest network of Advanced Technology and Intelligent Operations centers. Our 699,000 people deliver on the promise of technology and human ingenuity every day, serving clients in more than 120 countries. We embrace the power of change to create value and shared success for our clients, people, shareholders, partners and communities.Visit us at www.accenture.com

What would you do?

Responsible for managing a team of clinicians and non-clinicians charged with promoting quality member outcomes, to optimize member benefits, and promoting effective use of resources operating across the Health Management operation. Primary duties may include but are not limited to: Ensures adherence to medical policy and member benefits in providing service that is medically appropriate, high quality, and cost effective. Areas managed may include authorizing inpatient admissions, outpatient services, focused surgical and diagnostic procedures, out of network services, and appropriateness of treatment setting by utilizing the applicable medical policy and industry standards, accurately interpreting benefits, and managed care products, and may steer members to appropriate providers, programs, or community resources. Management responsibilities include hiring, training, coaching, counselling, and evaluating performance of direct reports. Responsible for providing oversight and support to the non-clinical, clinical and client teams to promote quality member outcomes, optimize member benefits, and promote the effective use of resources. Supports the procedures that ensure adherence with medical policy, the provision of member benefits and medically appropriate, high quality, and cost effective. Responsible for ensuring profitability is met and building/nurturing relationship with relevant stakeholders.

What are we looking for?

o Work hand in hand with the Operation Managers & Leads in making independent decisions, which have major day-to-day impact in area of responsibility, and may influence direction of other areas. o Accountable for results of work to both Accenture and client. o Accountable for medium-term planning, objective setting, and development of new procedures within area of responsibility. o Lead discussions and provide possible solution in addressing complex business problems/issues o Provides and assists in the implementation of business-focused solutions within time/cost constraints. o Self-directed within broad goals and strategic direction in satisfying organization or client objectives. o Responsible for developing and managing key internal/external client relationships across spheres of influence, including situations in which no relationship previously existed. o May participate in business development opportunities and communicate them to senior management. o Required to act as effective stand-in for immediate manager on operational direction of complex or large function or project, or medium size unit within stable mature operation, or key element of volatile environment. o Provides weekly status report detailing major work accomplishments, operations-related issues and risks, performance improvement opportunities, and upcoming activities o Provides daily end of shift reports in areas relating to team performance, end of day inventory, critical issues/concerns and other matters which need to be endorsed to the next shift o Accountable with team-specific activities, including productivity reports, attendance logs, end of shift reports, and other operations-related reports o Maintains updated team contact information, including home address, telephone number and emergency contact o Accountable in team reporting including service levels, financial performance o Develops team and individual performance data gathering metrics o Serves as initial point of contact for procedural and technical issues o Daily performance tracking is ongoing; daily, weekly and month to date performance of all associates are readily available o Schedules 1x1 coaching sessions in advance and coaching documentation is accomplished within the appropriate time frame o Derives data from client system and looks at current inventory levels to establish action items o Review's quality data (client audits and desk level audits)

Roles and Responsibilities:

o Cyclical work shift including work hours at night; able and willing to work U.S. time and as needed. o Overtime and On-Call may be required to meet the needs of client/business. o Employees able to travel to and work/train in the office as required and requested by management. o Additional tasks may be assigned by your Immediate Supervisor/Project Manager. o Minimum to no travel depending on project involvement. o Holidays are observed in compliance with client-specific contracts or statement of work (SOW). o For Remote/Work from Home Employees: Ability to work independently in a safe, private location with stable and secure internet connection with bandwidth sufficient for chat and videoconferencing (i.e., MS Teams), email and other required tools. Connectivity must meet project-specific requirements such as internet connection of at least 20 Mbps download speed/4 Mbps upload speed and ability to support privacy/security applications to ensure safe handling of protected health information. o Ability to participate in live video conferencing and screen sharing sessions during training and on an ongoing basis as required to perform role.




Any Graduation