Manager, Process Applications

Keystone Mercy Health Plan is Pennsylvania?s largest Medical Assistance (Medicaid) managed care health plan serving more the 300,000 Medical Assistance recipients in Southeastern Pennsylvania including Bucks, Chester, Delaware, Montgomery, and Philadelphia counties.

 

Headquartered in Philadelphia, Keystone Mercy Health Plan is a mission driven, health care ministry of the Sisters of Mercy with more than 20 years of experience.  Its corporate parent partners are Mercy Health System and Keystone First, a subsidiary of Independence Blue Cross.

 

Keystone Mercy Health Plan seeks a Manager, Process Applications to join our team of talented professionals in our Philadelphia, PA location.

 

Reporting to the Vice President of Operations, the Manager is responsible for ongoing analysis of operations data and the subsequent design and implementation of interventions that result in expert processes that produce zero defects. This position will work in a collaborative manner, primarily with the managers of provider relations, provider contracting, provider data maintenance, provider claims services, and the Facets Configuration to conduct ongoing quantitative and qualitative analysis of data to identify opportunities for improvement. Responsible for issue identification and resolution committee. Provides expertise in minimizing the volume of claims? billing and payment errors. Responsible for using sound judgment in escalating issues to senior and executive management in which resolution is delayed and operational performance is impacted. Responsible for leading the development and implementation of interventions aimed at improving Plan operational performance. Leads team in a manner conducive to ongoing growth and expanded knowledge of associates. Maintains strict adherence to Corporate Code of Conduct and compliance policies. Supports and carries out the Mercy Mission.

 

Required: BS or equivalent preferred. Minimum of 8-10 years of progressive experience in healthcare delivery required. Minimum of five (5) years experience in managed healthcare required. Minimum of five (5) years experience in clinical or service quality improvement required. Minimum of five (5) years project management experience preferred at the management level. One (1) year managed Medicaid experience preferred. Excellent written and verbal communication skills. Excellent organizational, analytical and interpersonal skills required. Ability to design, develop and implement projects to address financial, quality and service improvements. Ability to analyze existing and potential workflows, processes, supporting systems and procedures and identify improvements. Strong PC and project/decision facilitation skills.

 

Keystone Mercy Health Plan offers a competitive benefits package; salary that includes no city wage tax for non Pennsylvania residents, free parking and an exceptional work environment for an energetic individual who will join a team of competent and compassionate individuals to carry out our mission.  We pride ourselves on the opportunities available to our associates to learn, grow and advance their careers. EOE.

 

Interested applicants should submit resume, salary requirements, job code [MGRPROA] and three (3) professional reference to v alerie.thomas@kmhp.com