Operational Implementation Manager at Universal Healthcare Pty Ltd

verview:

The successful implementation of all scheme, provider and vendor (list is not exhaustive) related rules by the Data Admin Department
Ensuring that the Implementations department tasks are completed within defined SLAs
Ensuring that the Quality Assurance department tasks completed as per defined SLAs and SOPs focusing on Quality output
Manage all the Quality Control department tasks with a focus on Claim file transfers, QC of NAPPI codes, ERA’s, Providers Statements, etc
Manage the end to end Funder/ scheme reconciliation process in the Fund Control Department
Evaluate and implement procedures and processes within Operations Implementations department with a focus on continuous improvement and automation

Duties and Responsibilities

Operational Excellence

Ensuring all Implementation Documentation is systematically filed and up to date for ease of reference. (Implementation Forms, Checklists, Rule Lists, Rule Summaries, Audit Reports etc.)
Ensure highest quality external communication (Circulars, Levy Charts, Medprax files, etc.)
Ensure data / rules are loaded within defined timelines as to not compromise the Implementation go-live
Support all Projects where DA, Implementation, QC and Fund Control related tasks are involved
Ensuring end to end quality
Managing time lines effectively by proactively negotiating departmental deliverables
Build internal relationships with all functional areas involved in implementations in order to enhance cooperation and customer satisfaction
CIM Database to be maintained according to SOP MPD026
Assess and evaluate all applications and systems with a focus on Continuous improvements. Submit and follow through with NRRs for Improvements
Ensure all Funder reconciliation related tasks are effectively dealt with so as to not compromise provider payments.

Documentation

Ensuring that the implementation documents are in line with the various contracts and complies with SLA’s and ISO requirements.
All records/forms authorised according to SOP’s.
Ensure Circulars are accurate, easy to understand and distributed on time.
Electronic and manual filing system – ensure that this is managed correctly.
Historical record keeping – ensure effective historical record keeping in place and is maintained for audit purposes.
Ensure the update of the Implementation Forms with the agreed SLA’s, Legislation, New Functionality, etc. obtain sign-off and ensure training on the updated versions
Ensure all SOPs/ User manuals are updated and signed off by QMS within their defined departmental timelines.

Communication

Maintain internal and external communication as per SOP’s.
Set up sessions / meeting with interdepartmental stakeholder when necessary
Communicate effectively with Senior Managers when required, providing accurate and quality information.
Ensure open channels of communication for Staff – TEAMS, SKYPE, Emails.
Ensure availability after hours within reasonable requirements.

Project Management

Managing the time lines and quality of each DA, Implementation and QC task pertaining to relevant projects.
Manage Year-End, ensuring sufficient resource availability across the departments enabling all year end tasks to be completed on time with focus on quality.

Staff Management and development

Assist staff with prioritising and crisis management
Deal with all issues escalated by staff Build capacity within the department
Ensure adequate resources for Year-end Implementations
Coach staff on areas of development
Evaluate Staff training requirements, engage SME’s and ensure appropriate training occurs
Assist staff with problem solving
Ensure that departmental goals are achieved Performance Management, Job descriptions and Development Plans
Maintain monthly departmental meetings &action list

Departmental Analysis and Reporting

Analyse all incidents, identify root causes and action improvements with the focus on preventing it from happening again.
Analyse all queries logged on the Implementation Ops Queue in RT and action appropriately ensuring that SLA’s are not breached.
Monitor the RT dashboards to ensure that all requests are actioned as per SLAs.
Analyse SLA’s, report on non-compliance and action improvements
Negotiate, manage and enforce realistic SLA’s with other departments regarding
Implementation actions

SOP’S

Manage the SOP reviews as per the SOP schedule
Identify SOP’s that needs to be updated outside the annual review
Identify when new SOP’s are required and ensure the documenting, sign-off and training of these SOP’s before any Go-live.

Department Tasks

To review and maintain knowledge of SLA’s relating to the Data Admin and QC department deliverables.
Drive the incident process ensuring all incidents are resolved within agreed timelines
Facilitate smoother scheme implementation procedure by implementing pro-active measures to identify quality trends
Ensure appropriate functionality monitoring done for all projects, requests, implementations & code changes involving Data Admin and QC
Ensure requests are submitted timeously, of the appropriate quality, submission for prioritisation
Improve Quality management by linking quality achieved to individual staff member’s KRA documents
Identify continuous improvement opportunities, plan and implement improvements as per agreed procedures and timelines.

General

Ensure all internal and external audit finding are addressed and remedied as per the agreed timelines.
Conduct DR testing as per defined Test plan

INTERNAL RELATIONSHIPS (Who will he/she communicate with at the office in order to be able to meet his/her objectives?)

EXTERNAL RELATIONSHIPS (Who will he/she communicate with outside of the office
order to meet his/her objectives?)

EDUCATIONAL REQUIREMENTS (What are the minimum educational requirements for this position?)

BACKGROUND EXPERIENCE (What experience is required to manage this function successfully?)

SKILLS REQUIREMENT (What skills are required to manage this function
successfully?)

DIMENSIONS

PERSONAL MOTIVATIONS

The Employment Equity approach of Universal Healthcare broadly aims to:

Foster diversity in the workplace;
Promote equal opportunity and fair treatment in employment through the elimination of all forms of unfair discrimination.

Desired Skills:

Desired Qualification Level: