CSA Operations Manager

Blue Cross Blue Shield of Alabama; Birmingham (AL); Hybrid; USD 90,000 - 125,000; Full time

Job summary

Blue Cross Blue Shield of Alabama is seeking an experienced CSA Operations Manager to oversee audit and data analysis across subsidiary contracts. The role requires directing a diverse team of statisticians, auditors, and analysts, and designing projects across contract lines.

You will guide training and quality assurance initiatives while ensuring timely, budget-conscious execution of directives. The candidate should bring leadership experience, strong regulatory knowledge, and proven ability

Qualifications

• Bachelor degree and five years of supervisory or leadership experience.
• Knowledge of Medicare or other agency regulations and guidelines.
• Experience using statistical methods and data analysis techniques.
• Experience in leadership, team building and performance management.

Responsibilities

• Ensure data analysis, audit and appeal requirements across contracts are completed timely and within budget.
• Provide clear information and education regarding utilization of agency services to internal and external customers.
• Manage staff including statisticians, auditors and analysts, and design multiple projects across contract lines.
• Provide training and mentorship, and develop policies to improve workflow and quality assurance.

Skills

Statistical analysis

Leadership

Regulatory knowledge

Project management

Education

Bachelor degree in statistics, nursing, health care, business, accounting or related field

Tools

Database management systems

Job description

Overview

The Audit Department at our subsidiary has associates working remotely in several states with physical offices located in Birmingham, AL. This unit is responsible for work related to audits and appeals for a subset of institutional providers located across the country. The audit sector conducts Medicare audits on provider cost reports to determine payment and calculates the final settlement determination on the audited cost reports. The audit area also handles cost report appeals and reopenings from various other Medicare contractors, as assigned by the Medicare Administrative Contractors (MACs).

Primary Responsibilities

The CSA Operations Manager position ensures all data analysis, audit and appeal requirements of all subsidiary contracts are completed in a timely and accurate manner, within budgeted guidelines and to provide appropriate direction to assigned staff. Provide clear, accurate and timely information and education regarding utilization of agency services to internal and external customers. The incumbent manages and directs a diverse and highly professional staff consisting of Mastered level Statisticians, Auditors, and Analysts. The incumbent must develop, design, and implement multiple projects across contract lines.

The incumbent provides assistance, guidance and mentoring to the staff while also providing the initial and ongoing training for said staff. Providing guidance for application of regulations to audits and appeals, as well as coordinating and monitoring all quality improvement/quality assurance activities that provide the opportunity to identify areas for improvement and corrective action implementation are part of this positions basic functions. The incumbent interprets agency directives and effectively implements these directives into policies and procedure of the area.

This position also works with Operations Managers, Auditors, Statisticians, and Programmers in all subsidiary sites to ensure competency and consistency in work production throughout the Company. This position works with Regional and Central Agency Offices, as well as Attorneys and Consultants. The incumbent is charged with monitoring and detecting enhancements that may identify improvements to the workflow process and work distribution. In addition, the incumbent is charged with providing feedback to upper management concerning all areas of responsibility.

Summary of Qualifications

• Bachelor degree in statistics, nursing, health care, business, accounting or related field
• Minimum of five years of successful supervisory or leadership experience
• Knowledge of Medicare or other agency regulations and guidelines
• Experience in utilizing statistical methods and data analysis techniques
• Experience in a position utilizing leadership, team building and/or Performance Management skills to evaluate and improve the performance of the staff
• Experience developing ideas to effectively solve problems and effectively communicating these solutions to others for implementation
• Basic knowledge of database management systems preferred
• Experience managing Medicare audits and reimbursement audit and appeal processes is preferred

Terms and Agreements

By submitting a job application, I attest that all information to the best of my knowledge is true and accurate. Furthermore, I understand that any information provided by me throughout the job application process is subject to verification including, but not limited to work experience, education, assessment (test) and interviews.

We appreciate your interest in 'The Company'. The Company does not discriminate in hiring or employment on the basis of race, color, religion, creed, sex, sexual orientation, gender identity, national origin, age, disability, genetics, status as a disabled or protected veteran, or because of citizenship status in the case of a citizen or intending citizen. No question on this application is intended to secure information to be used for such discrimination.