Manager Resolution Center

Overview

The Manager of the Resolution Center is a highly visible position within Advocate Physicians Partners' management ream. This position is responsible for the planning, development, oversight and execution of quality customer service required to deliver on behalf of Advocate Health Centers and Advocate PHO's. This position is responsible for the development and monitoring of service standards by providing efficient, effective, timely and quality services to members, provider offices, managed care organizations and internal customers. The incumbent will serve as a liaison to Sr. Management, Site Directors and various departments within Advocate Healthcare, keeping them informed of trends and/or changes that will affect their respective areas. This position requires a comprehensive understanding of multiple business structures and the ability to lead change through example in a fast paced ever changing managed care environment. The Manager of the Resolution Center has significant responsibility for demonstrating a high level of integrity and innovative thinking required to actively contribute to the success of all teams as it relates to overall APP objectives. The scope of this position encompasses 200,000 covered lives, 6000 affiliated physician practices, 9 PHO's with aligned Advocate hospitals and 16 Advocate Health Centers. As Advocate expands its service area the incumbent will be responsible for ensuring quality and integrity are met.

Major Responsibilities:

ASSOCIATE MANAGEMENT: Create an environment, lead and direct Resolution Center associates in the promotion of quality and comprehensive services to ensure that quality customer service is provided to our members, physician practices, employers, managed care organizations as well as internal departments.

1) Direct staff in researching and resolving a variety of issues identified by our customers related to membership issues, referrals, intervention with provider offices related to collection agency involvement or access of care.

2) Develop and implement short and long range goals for the Resolution Center department, consistent with the organization's specified focus and objectives.

3) Responsible for creation, production and review of weekly and monthly call statistics provided to Director. These statistical reports are also distributed at monthly Financial Operations Performance Improvement team meetings as well as the APP Board of Directors monthly meetings.

4) Lead, mentor and develop growth opportunities for Resolution Center associates. Orient and maintain a highly motivated staff capable of successfully performing quality customer service and demonstrate the integrity of Advocate.

5) Assist Director, Claims, Recovery & Resolution Center in developing key strategic initiatives to improve the level of value-added services to provider offices, PHO's and Advocate Medical Group.

6) Conduct weekly Resolution Center meetings to promote staff education, continuity of customer service levels and solicitation of input from associates toward opportunities for improvement within the department as well as relationships with other internal/external entities. Develop, implement and monitor initiatives for internal team building

7) Responsible for the administration of and setting of priorities to manage rapid growth of APP customer service in the Advocate market share while providing efficient and effective high quality customer service.

8) Develop, administer and report on customer service satisfaction levels resulting from interactions with our customers. Identify areas of dissatisfaction. Develop, implement and monitor key strategic initiatives to resolve those issues identified.

9) Perform timely Resolution Center associate performance reviews and weekly evaluations. Responsible for all interviewing and hiring of all new Resolution Center associates.

10) Assist Director, Claims, Recovery & Resolution Center in developing key strategic initiatives to improve the level of value-added services to provider offices, PHO's, Advocate Health Centers and Advocate Medical Group.

PROJECT MANAGEMENT: Project manage all software modifications and/or upgrades and intervene with Advocate Information Technology and Telecom departments to coordinate, implement and monitor software after modifications are made. There are two critical software applications: Virtual Observer and Customer Service Software.

1) Virtual Observer Software: Monitors and records all inbound and outbound calls within the Resolution Center phone system. The software also provides screen capture functionality that records the associate's computer screen while recording the call itself. The incumbent uses this information to assess the performance and mentor associates in areas of opportunity.

2) Customer Service Software: This is the telecom software integrated with our Alcatel systems that monitor all calls inbound to the Resolution Center. This software provides incumbent with real time data on agent and call queue statistics including abandonment rates and quality statistics required to be met by our managed care contracted organizations.

3) Prepares all documentation and assures all project documents is complete and updated within departmental policies and procedures.

4) Ongoing monitoring and identification of issues related to the software.

5) Review and identify areas of improvement for software enhancements.

QUALITY CONTROL: Oversight of the Resolution Center associates responsible for updating/modification of eligibility information in IDX, review and reprocessing of claims payment (when deemed appropriate by the associate) resulting in a financial impact to the organization. Additionally, the associates direct the APP Finance Department in making financial funds adjustments to claims expense on behalf of all our customers when deemed appropriate by the associate. The incumbent is responsible to ensure that accurate eligibility and claims adjustments are made by the Resolution Center associates.

1) Responsible for preparation of weekly Resolution Center call statistics presented to the Director, Claims, Recovery & Resolution Center. These reports are also distributed at monthly Financial Operations Performance Improvement team meeting and to the Board of Directors on a monthly basis.

2) Responsible for preparation and participation in all MCO audits regarding the Resolution Center call monitoring and/or statistics. These audits typically are performed on an annual or semi-annual basis by each of the MCOs.

3) Responsible for any and all reporting related to call statistics required by the contracted MCOs.

MANAGED CARE ORGANIZATION AUDITS: The ability for APP to retain medical management and claims processing delegation is in part dependent upon exceptional resolution of issues on behalf of our members, provider offices, managed care organizations and internal departments.

1) Responsible for preparation of, presentation to MCO and detailed participation in all MCO audits regarding the Resolution Center call monitoring statistics and customer service levels.

2) Responsible for any and all reporting related to call statistics required by the contracted MCOs.