Noridian Mutual Insurance Company Team Leader Medical Review in Fargo, North Dakota

Requisition Number17-0334Post Date5/31/2017TitleTeam Leader Medical ReviewCityFargoStateNDDescriptionPrimary Objective of PositionTo facilitate and guide staff, to provide them with the tools and skills and guidance to become responsible for their workloads and their teammates. To influence the direction of Medicare in meetingNHS goals. To ensure workloads meet and exceed CPE standards in coordinating workloads for a multiple state contractor while operating within the Medicare and Corporate budgets. This position will fulfill the responsibilities related to Medical Review. An integral part of our appeals approach, our strategic management initiative helps Noridian process appeals as efficiently and effectively as possible. The practice is based on LEAN principles and was established working with industrial engineers. The result is the development of a visual control board called Quality, Delivery, Inventory, Productivity (QDIP) which is used daily at team huddles to review completes and receipts of appeals, allocation of resources, staffing levels, goals for each day and provides the ability to forecast workloads to process at the greatest amount of efficiency. Another tool called the Hour by Hour Tracker provides hourly completes per employee and displays them towards the daily goal. It also provides monthly, daily, and hour by hour tracking mechanisms for monitoring of workloads. We continually monitor production and inventory and can adjust daily or hourly if needed. Essential Functions1) Maintain a strong technical understanding of the systems used to manage Medicare business and the interrelationships between teams on system usage.a) Provide analytical and broad-based view of systems by acquiring and maintaining a thorough knowledge of all systems and subsystems used to administer the NHS MR program and other lines of business.b) Share knowledge with multiple areas at multiple sites.c) Serve as a resource point for internal/external customers.d) Provide ideas and innovative ways to improve system processes and reduce over utilization. 2) Serve as a primary contact to CMS and other external contacts on Medicare operations.a) Attend and/or conduct meetings, workshops, training sessions as appropriate.b) Assist with the identification and resolution of 'Provider relation' issues.c) Communicate concise speaking and writing to CMS and other external contacts, as necessary, on issues affecting contractor performance, workload, etc. for Medical Review.d) Write the MR section of the Monthly Status Report to CMS.e) Maintain knowledge of the Statement of Work (SOW) for MR including operational work, reporting and deliverables.f) Maintain knowledge and awareness of Fraud. 3) Conduct all aspects of hiring and maintaining staffing levels.a) Develop interview questions.b) Screen, interview and hire team members.c) Document selection criteria.d) Write and maintain accurate job questionnaires and job descriptions.e) Prepare and deliver Performance Appraisals and give constructive feedback on an ongoing basis.f) Initiate disciplinary action when performance does not meet expectations; document appropriately through work counseling.g) Terminate employees when necessary.h) Coordinate activities as appropriate with Manager and Human Resources. 4) Facilitate and coach staff to meet individual potential and performance expectations.a) Communicate performance expectations by meeting with staff periodically to ensure continuity and quality of service. Provide ongoing feedback on performance levels achieved.b) Communicate Noridian Healthcare Solutions goals.c) Communicate CMS rules, regulations, and standards (both SOW and Award Fee Plan).d) Ensure a work environment that is conducive to learning and skill development/enhancement.e) Ensure a work environment that allows employees to meet productivity standards.f) Look for innovative ways to promote efficiency and quality. 5) Maintain an empowered team environment.a