Sr. Manager, Performance Improvement

Requirements

• Bachelor's degree from an accredited institution or equivalent work experience.
• Experience leading complex process improvement initiatives.
• Experience managing staff
• Experience working with data sets and/or Microsoft Excel modeling
• Experience utilizing valuation and impact analysis methodologies
• Experience using workflow diagramming applications to document business processes
• Lean Six Sigma or similar process design and root cause analytics experience
• Data trend analytics experience, including mining and reviewing Claims data in Tableau
• Financial modeling experience, including creating complex ROI models for measuring baseline performance of current business processes and programs, and developing business cases to support proposals for new/expanded processes and programs, insource vs. outsource decisions, etc.
• Foundational understanding of GenAI (including decision-support and content creation solutions), ML predictive modeling, no-code and low-code automation technologies, and other clinical and business process automation solutions
• Experience working in a Scaled Agile Framework (SAFe) environment
• Project management experience (PMP preferred)
• Proficiency in medical terminology, medical coding (CPT4, ICD10, and HCPCS), provider contract concepts, and common claims processing/resolution practices
• Experience with facility reimbursement methodologies (i.e., Diagnostic Related Groups, DRG; Ambulatory Payment Classification, APC; or Ambulatory Patient Group, APG, etc.)
• Understanding of payment and billing principles for physician or other professional services (i.e., ancillary, behavioral health, Long Term Care, etc.)
• Knowledge of Medicare and Medicaid programs and reimbursement methodologies a plus
• Knowledge of healthcare claims processing practices in a managed care setting a plus
• Knowledge in clinical and claims decision-making a plus (including understanding utilization trends, provider contracts and revenue cycle, regulatory and legal requirements, clinical program design, waste and abuse concepts, etc.)
• Background working in Payment Integrity, Utilization Management, or similar operations, including understanding Clinical and Claims staffing models and skillsets, a plus
• Preferably active RN license and/or Certified Professional Coder
• Compliance & Regulatory Responsibilities: NA
• License/Certification: Six Sigma Black Belt or other PI Methodology preferred
• Hiring Range :
• Greater New York City Area (NY, NJ, CT residents): $119,900 - $183,430
• All Other Locations (within approved locations): $102,600 - $156,655
• As a candidate for this position, your salary and related elements of compensation will be contingent upon your work experience, ed

Additional Information

Description and Requirements The Senior Manager of Performance Improvement leads and coordinates multiple projects across a portfolio of work and partners with business leaders to deliver measurable value aligned to strategic goals and company priorities. The Sr. Manager provides leadership in the planning and deployment of continuous improvement to optimize business processes across the organization. The Senior Manager is a key contributor in the long-term strategic planning of the Performance Improvement Department to drive results. Duties & Responsibilities: Identify and/or direct process improvement opportunities and provide preliminary benefit/financial valuation for project prioritization Lead cross functional teams in successful completion of assigned projects; generate solutions to complex problems through utilization of problem-solving tools and methodologies Maintain up-to-date knowledge of all assigned initiatives, with a focus on measurable value Coach, train, and educate business teams on how to leverage performance improvement tools and methods Establish strong collaborative relationships with project sponsors, key stakeholders, business leaders and teams Drive claims quality improvements, including leveraging data analysis to improve E2E claims payment accuracy and drive reductions in claims rework, disputes, and audit errors Identify and lead/support claims configuration efficiency and quality enhancements, including optimizing processes for Provider Data, Reimbursement, New Code Implementation, Authorizations, Benefits, Claims Editing, etc. Support Payment Integrity process improvements and program optimizations for Overpayment Recovery, COB, and Claims Editing Provide performance improvement support for Claims and Provider Payment Modernization (PayDoc) initiatives Identify cost trends from a variety of data reports, quantify and make recommendations that align with Healthfirst's strategy and both our internal and vendor capabilities (including evaluating staffing volumes, skillsets necessary to perform the work, IT needs, etc.), effectively lead the project with the operational area(s) to completion, and monitor ongoing success and make changes as appropriate to deliver the expected cost savings

Your Match

How well this role fits your profile.

Company Intel

What employees say

Worked at Healthfirst? Share your experience