This position is responsible for the daily management of a team, process improvement projects and inspection activities in the GuideWell Source Quality department, in support of promoting a culture of continuous process improvement throughout GuideWell Source and its affiliated companies.
ESSENTIAL DUTIES & RESPONSIBILITIES
Provide leadership and direction to a team of employees in order to effectively achieve established goals and objectives through: o interviewing, developing and training o coaching, counseling and motivating o assessing and evaluating o planning and decision-making o analyzing, problem-solving and executing
Manage the day-to-day Quality function for a team of data analysts and reviewers to deliver results that meet/exceed corporate objectives and fulfill service level agreements (SLAs): o Manage workload to ensure SLAs are met, including managing time-off requests and other impacts to business continuity o Gather data and calculate workload models to allocate resources to achieve production and quality results under various scenarios o Resolve any timekeeping or attendance issues for the staff o Conduct team meetings and one-on-one meetings in a timely and effective manner o Provide monthly reports to internal and external customers Provide performance feedback to Quality team members monthly, mid-year and end-of-year o Resolve rebuttals of quality inspections raised by operational functions, including escalated rebuttals from operational management o Actively foster effective partnerships with internal and external customers
Develop and maintain processes, tools and reports for the inspection activities of operational functions by organizing people and activities, establishing goals, and communicating requirements throughout the company to achieve effective and efficient improvements: o Lead and execute large-scale process improvement projects to enable the Quality team to improve its support of operations, including, but not limited to system applications/databases, process re-engineering and reports o Lead the standardization and collaboration efforts to leverage economies of scale for the quality inspection process o Facilitate root cause analysis and action planning with operational areas to decrease errors; oversee the appropriate use of inspection resources to improve operational efficiencies o Develop and maintain training plans and training materials, and coordinate the training of the Quality staff by collaborating with the operational functions being inspected o Consult with the operational functions being inspected at least annually, and as significant process changes occur in operations or in the SLA o Assess effectiveness of inspection processes (and related training or skills enhancements) at least annually and revise as needed
High School diploma or equivalent • 4 or more years of quality audit and/or process improvement experience, with at least 2 years in a supervisory or management role in a service or process environment, such as processing claims, call center management, medical or hospital administration • Knowledge of ISO 9001 for Quality Management Systems, auditing protocols, concepts and standards and other quality tools and principles, such as Lean or Six Sigma • Excellent verbal and written communication skills, i.e., the ability to speak in a clear and articulate manner and to write reports for senior leadership • Demonstrated project management experience • Experience in formulating short and long term operational plans and making complex decisions • Strong business analytical and quantitative skills • Effective interpersonal skills and proven ability to work in a team environment and effectively interact with all levels of management • Proven track record of leadership, negotiation and successful conflict resolution • Proficient in Microsoft Office Suite (or comparable Excel, Word and PowerPoint skills) • Lean or Six Sigma, ASQ Certified Quality Auditor, similar certification or equivalent experience
Bachelor’s degree in relevant field • 5 years of quality audit/process improvement experience with 3 years of supervisory/management experience in a Medicare, Medicaid, Tricare, commercial insurance or similar processing environment • Demonstrated knowledge of quality management principles and tools including Statistical Process Control, Lean or Six Sigma, Balanced Scorecard, quality system auditing, inspections sampling techniques or Total Quality Management.
Certifications, Licenses, Registrations
Project Management certification
"We are an Equal Opportunity Employer/Protected Veteran/Disabled"
Employer will assist with relocation costs.
GuideWell Source is a leading administrative services company providing full-service, administrative business solutions for health programs.
GuideWell Source, headquartered in Jacksonville, Florida is the corporate shared services and parent company of its wholly owned subsidiaries First Coast Service Options, Inc. (First Coast) and Novitas Solutions, Inc. (Novitas), and GuideWell Allegiance, Inc.
Guided by our values of doing the right things, the right way, the GuideWell Source family of companies is committed to conducting business with integrity and operational excellence while continuously improving our organization and business processes and providing fiscal responsibility in service to our customers. Our family of companies has strong relationships with business partners like the Centers for Medicare and Medicaid Services (CMS); deep traditional Medicare knowledge, and strong program management capabilities necessary to service health plans, payors and government sponsored healthcare programs.
Our vision which includes maximizing market share and delivering exceptional service to a diversified customer base aligns with the innovating and changing marketplace of heal...thcare solutions. We will achieve this through leveraging our deep knowledge and relationships as well as our core capabilities and remaining true to our mission of providing best value administrative services.
First Coast and Novitas provide administrative and claims processing services for state and federal health care programs such as Medicare and Medicaid. First Coast and Novitas contract with CMS to provide quality Medicare administrative services throughout the United States to more than eleven million beneficiaries and the five hundred thousand health care providers who care for them. The services provided include claims processing, customer service, appeals adjudication, education and outreach activities, and functions that help promote the integrity of Medicare program payments. First Coast is the Part A and Part B Medicare Administrative Contractor (MAC) for Florida, Puerto Rico, and the U.S. Virgin Islands (Jurisdiction N). Novitas is the MAC for Delaware, District of Columbia, Maryland, New Jersey, and Pennsylvania (Jurisdiction L) as well as Arkansas, Colorado, Louisiana, Mississippi, New Mexico, Oklahoma and Texas (Jurisdiction H). As MACs, First Coast and Novitas represent approximately one-third of the entire Part A and Part B Medicare landscape.