Operations Regional Manager

New York, NY

Posted: 02/14/2020 Job Number: 13940479

Job Description

A rapidly growing organization is looking for an Operations Regional Manager who will be responsible for the daily management of assigned accounts.


Responsible for the daily management of the DRG unit including staff and the assigned accounts

Manage workflow and monitor productivity to ensure claims are processed within timeframes

Ensure inquiries are responded within the department standards

Ensure account issue logs are maintained and updated accordingly

Interface on a daily basis with Assistant Director as it relates to pending deliverables and provider specific issues

Review quality results of work performed to ensure accurate processing and communicate findings to the Assistant Director

Ensure timely and appropriate follow-up on outstanding deliverables

Ensure systems are updated timely and appropriately when documents are received

Review, weekly and quarterly reporting to ensure accurate reporting

Identify and take action on potential late cases

Manage workflow of External (Plan, CMS IMEDICES, A&G, etc.) Reviews

Work with Assistant Director and staff to ensure potential issues are communicated effectively and timely

Interface directly with assigned Plan liaisons as determined by the client

Insures the training of all staff

Assist in the coordination of Special Projects

Monitors all staff performance and initiate action plans as necessary

Assist in the implementation of new accounts

Assist in the development of and implementation of policies and procedures to Review Operations unit

Communicate with Client and External Liaisons on issue specific to assigned accounts

Attend all client meetings as it relates to DRG

Perform other related duties as assigned


Bachelor Degree in health care or other related field / Masters I Public Health Preferred

Minimum two years' experience in working within the health care industry

Proven history of working with DRG and EAPG claims

Experience in working with Electronic Medical Records (EMR)

Management experience preferred


Strong analytical skills

Highly organized, detail oriented work skills

Ability to prioritize and organize workload and complete tasks independently

Ability to multi-task and work within a fast paced environment and under conditions where timeliness is critical

Ability to quickly comprehend information from oral and written documentation

Knowledge with medical claims terminology and medical claim audit process

Knowledge of components of a medical record

Excellent written and verbal communication skills

Excellent computer skills in using all MS Office software (Word, Excel, Outlook, PowerPoint, Visio...)

Knowledge of principles and practices of organization, planning, management, and general administration

Ability to supervise a team

Meet Your Recruiter

Jessica Swanson

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