Job Description

Job Location: iLIFE Main - Milwaukee, WI 53233Education
Level: 2 Year Degree or Equivalent Experience
Travel Percentage: NoneJob Purpose: The Provider Operations Lead works as a liaison between iLIFE management, staff, and stakeholders enacting policies, and procedures to ensure optimal service is provided. This role helps the supervisor manage and motivate multiple teams and compiles and analyzes team data to identify trends and opportunities to drive effective performance results.
Essential Job Functions:
(Reasonable Accommodations may be made to enable individuals with disabilities to perform these essential functions.)
- Serves as the primary lead of the Data Verification Specialist team, the vendor claims team, and the claim resolution team.
- Monitoring performance, work schedules, and productivity standards for each team individually.
- Act as the first point of escalation for Provider Operations Staff.
- Lead the training of staff and implementation of new processes.
- Leads and supports the workforce in problem identification, problem solving and implementing continuous improvement measures.
- Communicates and assists in enforcing department and company policies and procedures.
- Help manage and ensure smooth day-to-day operations of business-critical workflows, developing specifications/guidelines and resolving escalations.
- Leads staff in processes and procedures that drive effective performance results.
- Produces and creates reporting as needed.
- Provide detailed information regarding problem payments to management.
- Process payroll weekly in accordance with state deadlines.
- Foster a positive and representative work environment of CFI mission and values, promoting development of acceptable work ethics.
- Maintains confidentiality.
- Ensures compliance with state and regulatory requirements.
- Verify compliance with the federally required Electronic Visit Verification regulations by overseeing the daily tasks of the Data Visit Verification team.
- Effectively manages escalations within the department by ensuring appropriate accountability, sense of urgency, communication and follow through to closure.
- Engages and works collaboratively with all levels of personnel within the company to achieve common goals.
- Maintain records of operational activities.
- Performs special assignments and or projects as assigned.

Qualifications

Required Education, Experience, Certifications, Licensure and Credentials: (Where appropriate, education and/or experience may be substituted)
Minimum

Required Education: Associate degree OR equivalent work experience in a related field.
Minimum Required

Experience:  Minimum of 2 years of related experience. Experience working with culturally diverse populations.
Required License – Certification – Registration:
Issued By Governing Body (if applicable):  N/a
Knowledge – Skills – Abilities:
- Strong leadership and motivational skills
- Past experience mentoring and/or training teammates
- Customer relationship management, respond escalated provider emails, calls, and/or any other communication. ,
-  The ability to read and interpret financial data to help ensure an accurate payroll runExcellent organizational skills and ability to multitask while working in multiple systems.
- Demonstrated strong computer knowledge and proficiency in Word, Excel, and Outlook.
- Demonstrated project management skills and ability to manage multiple tasks in a dynamic environment.
- Ability to work independently, effectively manage time of the teams that they lead and multitask in a fast-paced environment
- Accepts personal responsibility for the quality and timeliness of work and assumes ownership of the results.
- Adapts quickly to change.
- Ability to perform tasks accurately and abide by MCFI policies.
- Skill and ability in making decisions, considering a variety of complex factors.
- Demonstrate good communication skills
- Exhibit assertiveness, flexibility, and ability to maintain positive relationships.
- Ability to maintain strict confidentiality and comply with Health Insurance Portability and Accountability Act (HIPAA).
- Self-directed learner.
Physical Requirements, Visual Acuity, and Work Conditions:
Physical Requirements: Exerting up to 10 pounds of force occasionally and/or a negligible amount of force frequently or constantly to lift, carry, push, pull or otherwise move objects, including the human body. Sedentary work involves sitting most of the time.
Visual Acuity: The worker is required to have close visual acuity to perform an activity such as: preparing and analyzing data and figures; transcribing; viewing a computer terminal.
Working Conditions: Work conditions may be stressful at times. Most of the work will be performed in an office environment. Additional time and effort beyond a normal workweek may be required to accomplish company and individual objectives and to provide a high level of service to our members.
This is a general outline of the essential functions of this position and shall not be construed as an all-inclusive description of all work requirements and responsibilities that may be inherent in this position. The employee may be required to perform other job-related duties as requested by the designated work leader(s). All requirements are subject to change over time. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions of this position.
CFI is an Equal Opportunity Employer and promotes a Drug Free Work Environment