Deputy Director (Operational Claims) NHS
Deputy Director (Operational Claims) NHS, London, POD, MDT, Claiming, Claimer, Contract Management, Directing, Strategic, Strategy, Health, National, Claiming, Data Standards,
Context of the role
The Head of Operational Claims Management will provide senior leadership to the Claims Management Operational team as well as act as the in-house source of expertise and advice on the application of NTPS and national data definitions. The post holder will work in partnership with stakeholders and the CSU and CCG Boards to deliver a high quality information service with regards to claims management
Role specific duties and responsibilities
- Provide leadership to the Claims Operational Teams who will oversee the smooth management of the claims process, ensuring maximum return for CCGs, development of new claims and links into the overall contracting process
- Support the contracting POD/MDT teams as an expert in-house source of knowledge and advice on NTPS technical development and management. Chair internal working groups as required.
- Support the contracting round by providing advice on the development of the reporting requirements schedule (Information schedule) and acting as the lead on any updates or changes to national guidance
- Ensure that relationships are in place between the Claims Operational Team and POD/MDT Leads to support the Finance and Contracting process and deliver organisational objectives and support the Acute Contract Management function
- Lead the Claims Operational teams to flag potentially mischarged claims along with re-imbursement of mischarged activity informing part of a reconciliation process along with actual reimbursement of mischarged activity
- Act as a senior point of escalation for all Claims issues and supporting the MDT/POD teams to ensure Claims resolution and maximise Claims returns
- Responsible for the co-ordination of the Claims operational teams to ensure a standard, consistent and quality of service is provided
- Responsible for data and service quality, defining polices and processes to ensure good practice and adherence to regulatory requirements.
- The post holder is accountable as a senior manager for implementation of Standard Operating Procedures (SOPs) in the work of their teams, and for ensuring their staff are trained in using SOPs. In addition they are expected to champion the use of SOPs, include training in all induction programmes for new staff and development plans for existing staff, and contribute to the creation and maintenance of SOPs as required as part of the corporate SOP development process.
- Provide leadership to ensure that SOPs are appropriately managed including arranging for senior level sign-off of any agreed changes
- Work closely with POD/MDT and the Claims Technical Teams to co-ordinate the efforts of automated claims management and the NTPS challenge process to ensure maximum financial returns for lowest costs.
- Responsible for the conduct of all claims and potential claims
- Provide information leadership and support with regards to the claims management process
- Support the information management of all data held for the purposes of Claims Management, ensuring information is of appropriate quality and managed in line with Information Governance protocols across the CSU and external customers of the Claims process.
- Lead and develop a team of specialists to create and deliver processes for the service and ensure their continuous improvement.
- Production and communication of formal and complex presentations to large groups and senior audiences
- Responsible for working with different stakeholders (CCGs, Local Authorities, Trusts) to ensure the claims system and process is understood and the often highly complex results are communicated and explained clearly
- Ensure that the delivery of the Claims Operational services are monitored and maintained to the high levels of quality, standards and operability as defined within negotiated and agreed service level agreements, parameters or contracts.
- Ensuring compliance with the Data Protection Act 1998 in so far as it relates to claims management and NHS guidance
- Ensuring that the organisation's policy and systems for claims management are continually reviewed
- Able to effectively lead and manage a team within a Matrix structure, where there are multiple points of accountability. The CSU will be a fluid and evolving environment and it is expected managers are able to cope with ambiguity, work collaboratively in cross functional teams and manage multi interfaces.
- Experience of senior management within a large healthcare organisation
- Experience in writing high quality complex reports
- Business case development
- Leadership of Staff
- NHS Data Standards
- Information Governance
- ISO Standard Processes
- In depth knowledge of NTPS rules
- In depth knowledge of NHS Contracting and Finance Processes