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Call Center & Policy SME Manager

Acentra Health
paid time off
United States, Wyoming, Cheyenne
Apr 03, 2025
Company Overview

Acentra Health exists to empower better health outcomes through technology, services, and clinical expertise. Our mission is to innovate health solutions that deliver maximum value and impact.

Lead the Way is our rallying cry at Acentra Health. Think of it as an open invitation to embrace the mission of the company; to actively engage in problem-solving; and to take ownership of your work every day. Acentra Health offers you unparalleled opportunities. In fact, you have all you need to take charge of your career and accelerate better outcomes - making this a great time to join our team of passionate individuals dedicated to being a vital partner for health solutions in the public sector.


Job Summary and Responsibilities

Acentra Health is looking for a Call Center & Policy SME Manager to join our growing team.

Job Summary:

The Call Center & Policy SME Manager is responsible for providing leadership and direction for the Call Center and ensuring operational integrity in compliance with all policies and procedures. This includes monitoring and directing the overall activity and performance of the Call Center staff, working with senior management to establish priorities, standards, and performance objectives for the Call Center, and preparing and maintaining performance and productivity reports for their program's Call Center. The Call Center & Relations, Manager is the primary point of contact for provider and member complaints.

Responsibilities:

  • Directs and/or manages all activities associated with Call Center operations
  • Collaborate with implementation teams, IT, and other relevant stakeholders
  • Ensure the successful incorporation of additional service lines
  • Streamline work procedures, prepare work schedules, and expedite workflow for prompt and efficient task completion
  • Build and expand professional relationships with internal and external customers and colleagues
  • Maintains and enhances customer services by organizing and evaluating service, delivery systems and procedures
  • WY Medicaid Policy SME - work closely with BAs, Systems Manager, Claims Manager, Medical Policy Manager, and the Agency
  • Point of Contract for the Agency for provider and member complaints
  • Monitor coverage and billing policy changes and update the BMS Contractor policies, as applicable
  • Ensures call center staff are utilizing current Medicaid policies to assist providers and members with understanding claim adjudication, proper billing practices, and training needs
  • Works with Provider Representatives to ensure understanding of the Medicaid policies relevant to provider inquiries and necessary provider training
  • Act as liaison to resolve issues between call center and all departments
  • Develop and monitor effective quality assurance protocol
  • Validate and monitor call center metrics and service levels and hold the call center team accountable
  • Demonstrated leadership skills and ability to be a team player
  • Must be able to tolerate frequent work interruptions, organize work and reset priorities in order to complete work assignments in a timely manner
  • Work efficiently both individually and within a team to accomplish required tasks
  • Responsible for responding to customer inquiries and complaints
  • Monitor and develop as needed a variety of real-time inbound and outbound voice-based communications
  • Update job knowledge by participating in educational opportunities and training activities
  • Ensure all contractual SLA are in place and met
  • Monitor staffing goals of the call center to ensure fiscal responsibilities
  • Knowledgeable in call center monitoring tools that provides services for scripting, call flows, IVRs stats, and call recording
  • Work closely with all vendors that support the call center
  • Work closely development team to ensure system enhancements supports all call center functions
  • Work closely with the training team a new call scripts and process are developed
  • Read, understand, and adhere to all corporate policies including policies related to HIPAA and its Privacy and Security Rules

The list of accountabilities is not intended to be all-inclusive and may be expanded to include other education- and experience-related duties that management may deem necessary from time to time.


Qualifications

Required Qualifications

  • Bachelor's Degreein a related field and a minimum of five years of management experience in a healthcare or insurance call center environment; or an equivalent combination of education and experience
  • Minimum of 8 years in a customer contact service/call center related to healthcare or medical bill processing or similar environment; 3 years of that experience in a call center supervisory role, demonstrating the ability to provide guidance and direction in tasks of similar size and complexity (may overlap with other experience)

Preferred Qualifications

  • Possess a strong background in analysis and reporting
  • Proficient in managing customer service through call center technologies and systems
  • Skilled in using Microsoft Office and other relevant programs
  • Demonstrate experience in planning and implementing projects
  • Experience in managing customer service, conflict resolution, and crisis de-escalation
  • Strong focus on partnership and can develop and expand relationships
  • Adept in handling contract and provider relationships
  • Respond promptly to customer needs, solicit feedback to improve service, and meet commitments
  • Excellent written and oral communication skills
  • Possess outstanding interpersonal skills
  • Excellent organizational skills
  • Independent and takes initiative
  • Handle multiple priorities with varying deadlines

Why us?

We are a team of experienced and caring leaders, clinicians, pioneering technologists, and industry professionals who come together to redefine expectations for the healthcare industry. State and federal healthcare agencies, providers, and employers turn to us as their vital partner to ensure better healthcare and improve health outcomes.

We do this through our people.

You will have meaningful work that genuinely improves people's lives across the country. We are a company that cares about our employees, and we give you the tools and encouragement you need to achieve the finest work of your career.

Benefits

Benefits are a key component of your rewards package. Our benefits are designed to provide you with additional protection, security, and support for both your career and your life away from work. Our benefits include comprehensive health plans, paid time off, retirement savings, corporate wellness, educational assistance, corporate discounts, and more.

Thank You!

We know your time is valuable and we thank you for applying for this position. Due to the high volume of applicants, only those who are chosen to advance in our interview process will be contacted. We sincerely appreciate your interest in Acentra Health and invite you to apply to future openings that may be of interest. Best of luck in your search!

~ The Acentra Health Talent Acquisition Team

Visit us at Acentra.com/careers/

EEO AA M/F/Vet/Disability

Acentra Health is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, status as a protected veteran or any other status protected by applicable Federal, State or Local law.

Compensation

The pay for this position is listed below.

"Based on our compensation philosophy, an applicant's position placement in the pay range will depend on various considerations, such as years of applicable experience and skill level."


Pay Range

USD $75,840.00 - USD $118,500.00 /Yr.
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