Proactively drive vendor operations knowledge management performance to achieve contractual targets. Frequently interface with knowledge management counterparts of vendors to continuously improve policies, procedure, training material and other resources for Provider File and Credentialing core processes and to achieve end-to-end results across the EmblemHealth value stream. Continuously and proactively assess and monitor Provider File Operations via the Monthly Provider Directory Accuracy Audit to ensure contractual targets are achieved. Align methodology and scoring with Vendor (Cognizant) and external regulatory auditing entities. Personally, own the EmblemHealth brand and customer experience by directing continuous quality improvement.
- Design, implement and evaluate complex quality and process improvement, required to support Medicare Stars and regulatory needs to drive specific operation quality improvement outcomes.
- Drive knowledge management performance of vendors for each core process to meet contractual requirements and align with EmblemHealth customer experience objectives.
- Direct and manage vendor knowledge management counterparts by conducting reviews and training, transactional audits, policy, procedure and knowledge management program verifications and compliance reviews.
- Drive internal and external audit and compliance initiatives, including research, response, assessment of root cause analysis and corrective action, monitoring, scheduling.
- Collaborate and coordinate with Internal and External Auditors to improve integration of governance, risk, and compliance functions.
- Ensure compliance with regulations and controls by examining and analyzing records, reports, operating practices, and documentation; recommending opportunities to strengthen the internal control structure.
- Support Medicare Stars and Human Speak initiatives as needed to align policies, procedures and knowledge of vendors with corporate objectives.
- Identifies need for and assists in design, implementation and monitoring of operational processes/activities to assure compliance with standards
- Research, develop and identify internal and external barriers/root causes that affect that impact poor operational performance and ensure that implementation of strategies to overcome these barriers.
- Develop all policies for respective Tower and cascade information to all vendors as required to align knowledge.
- Serve as resource to improve operations through process improvement, strategic planning and managing change
- Align vendor policies and procedures with internal policy documentation as required.
- Work cross-functionally to plan, organize, design, develop, communicate and implement training-related programs that ensure clarity of message, define “actionable” items and outline expected business results.
- Communicate and collaborate with internal stakeholders (including but not limited to Marketing and Communications, Product Management, Network and Medical Management, Compliance and Quality Management) as needed to support overall EmblemHealth quality and customer experience objectives.
- Be proactive and clear (use Executive Briefing Tool) when communicating milestones and status
- Performs other duties as assigned or required.
- BS or BA degree
- Additional years of related experience may be used in lieu of Degree
- Achieve Quality Management / Organization Excellence certification or equivalent certification within 1 year of assuming this role
- 5-8 years of relevant experience in Knowledge Management and Improvement, Change Management, and Customer Experience required
- Energy, drive and passion for End-to-End excellence and customer experience improvement required
- Excellent collaboration skills and the ability to influence management decisions required
- Strong problem solving and analytical skills that be applied across all types of business problems required
- Strong facilitation, oral and written communication and presentation skills required
- Solid coaching and mentoring skills to continuously develop staff core competencies at vendors required
- Requisition ID: 200CF