Be responsible for setup, analysis and adjudication of the Medicare Prospective Payment System for inpatient and outpatient claims including but not limited to the 3M Diagnosis Related Grouping (DRG) and Tricare Outpatient Prospective Payment (OPPS) software systems.
The mission of this group is to provide 24x7x365 operational and administrative support for the client and to manage all incoming and outgoing support requests related to the network and business infrastructure while working with internal and external customers and teams to drive and coordinate issues to resolution within defined SLAs.
Participating in and leading project workstreams, writing and reviewing business requirements, testing new development, participating in the conversion process for client onboarding projects, and process documentation.
In this role, you will be responsible for evangelize and establish methods to manage by measurement. Work alongside the technical and operational organizations to optimize Customer Experience, System Quality and Operational Efficiency.
Update / distribute daily/weekly/monthly operations reports; development of reporting tools to support business requirements; coordinate with education group and other partners on business update needs to meet deadlines.
Utilize knowledge of business processes to analyze and interpret data to provide recommendations to leadership on trending, benchmarks and correlations between behaviors and results to improve the business function.
Formulate and apply mathematical modeling and other optimizing methods to develop and interpret information that assists management with decision making, policy formulation, or other managerial functions.
Identify, measure, and monitor the company's operational risk in how its transactions and infrastructure function. Assess risks from unauthorized trading, software or hardware failures, lack of oversight of operations, or contingencies that would prompt disaster recovery programs.