Director of Exchange Operations

Colorado Access•Aurora, CO

5d•Hybrid

About The Position

The vision of Colorado Access is to have healthy communities transformed by the care that people want at a cost we can all afford. Our mission is to partner with communities and empower people through access to quality, affordable care. Why should you consider a career with Colorado Access? We are a Colorado-based company, working to improve the health of our state. We care for individuals, families, and children who receive health care under Child Health Plan Plus (CHP+) and Health First Colorado (Colorado's Medicaid Program). Our focus is driving improvements in quality, member experience, outcomes, and cost. We are a mission-driven organization whose foundation is built by our vision, supported by our values and pillared by diversity, equity and inclusion. Find work/life balance: We offer PTO, floating holidays, nine company paid holidays, a hybrid work environment, an Employee Assistance Program and a 401K. Be a part of something bigger and make an impact: We serve the underserved and most vulnerable populations in our community through access to quality and affordable health care. No matter what you do for Colorado Access, you are impacting our community and making a difference. Sharpen your skills, learn, and grow: We support your continued development through tuition reimbursement, leadership training, promotion opportunities, performance evaluations, employee recognition, and a language pay stipend. What you will do: We are looking for a DIRECTOR OF EXCHANGE OPERATIONS who can help shape our vision and support our mission. Here is what the position will look like. Department Director Responsibilities: Provides strategic direction and oversees the management and maintenance of department deliverables striving for operational excellence (productivity, quality, SLAs, customer experience of services provided, etc.). Builds high performing teams with vision, leadership, goals and metrics. Serves as a role model for team members; takes action and inspires team members to embrace and implement culture initiatives. Provides awareness to staff how their work impacts other departments, programs and the enterprise. Encourages collaboration and holds team members accountable for achieving outstanding results. Responsible for all management functions including: hiring, training, planning and directing work, coaching and staff development, managing and evaluating performance, recognizing and rewarding employees; corrective action procedures and practices, addressing complaints and resolving problems. Develops and manages the department budget. Works closely with Directors across the organization to make tactical and operational decisions that advance company strategies and goals and collaborates to deliver on company-wide deliverables/requirements. Oversees/leads departmental projects and continuous improvement initiatives; may lead cross functional teams. Develops and implements department policies and procedures to ensure compliance with federal, state, local and company policies, rules and regulations. Job Specific Responsibilities: The Director of Exchange Operations works collaboratively with company operations, functional areas, other lines of business, and external vendors to identify opportunities for process improvement to drive compliance and efficiency Facilitates transparent communication around objectives and performance between Exchange Segment, Enterprise functions and local health plan Operations Proactively develops, tracks, and reports performance relative to Marketplace compliance requirements, key performance targets and/or associated service level agreements to Exchange Segment leadership Quickly escalates performance issues to the Exchange Segment leader and works collaboratively to develop action plans to mitigate Works collaboratively with corporate business owners, local health plans and the Exchange Segment to identify best practices and opportunities for process improvement to drive compliance and efficiency Develops strategies and tactics in partnership with Health Plan Service Operations to mitigate any performance issues to ensure established service levels are met (i.e. claims accuracy, G&A timeliness, etc.) Directs analytical activities to identify trends and potential opportunities for root cause analysis with those Corporate Operations functions that may impact the functionality of Marketplace Operations Closely partners with Compliance and Internal Audit to identify risk areas and ensure appropriate oversight and closure of internal and external corrective action plans Ensure adherence to federal, state, and local ACA regulations including CMS, HIPAA, and other relevant standards. Partner with compliance officers to maintain audit readiness and contractual obligations. Implement quality assurance protocols and performance metrics. Partners with project management/implementation leader to create and execute on plans for risk mitigation and process improvement. Provides oversight for provider relations operations to support the Account Executive function. Other operational duties as assigned Lead and mentor a high-performing team across operational functions. Manage vendor relationships to ensure service quality and cost-effectiveness. What you will bring: Education: Bachelor’s degree in healthcare administration, public policy, business, or related field; or an equivalent combination of education and experience. Master’s degree preferred. Experience: Minimum of seven years of progressive experience in ACA Individual, Medicaid/Medicare managed care, or health insurance operations. Five years of supervisory or management experience required. Strong understanding of healthcare systems, payer/provider relationships, and exchange operational workflows. Knowledge, Skills, and Abilities: Demonstrates support for the company’s mission, vision and values. Position requires excellent written and verbal communication skills. Must be proficient in Microsoft office applications (Word, Excel, PowerPoint, Outlook, SharePoint) with ability to work with a variety of project management tools. May be required to manage multiple priorities and projects with tight deadlines. Deep understanding of ACA Exchange dynamics and government program operations. Experience in high-growth environments and managing remote or hybrid teams. Ability to translate strategic goals into measurable operational initiatives. Proven ability to manage multiple priorities and deliver results in a fast-paced, evolving environment. Experience with CRM systems, quoting tools, and automation platforms is a plus. Licenses/Certifications: A valid driver's license and proof of current auto insurance will be required for any position requiring driving. Together we will be: an innovative and collaborative team who supports each other, the employees and vision of the company to reach our goals individually, together and as an organization. Pay, Perks and Benefits at Colorado Access: The compensation for this position is $149,700.00 - $190,000.00 annually. Colorado Access has provided a compensation range that represents its good faith estimate of what Colorado Access may pay for the position at the time of posting. Colorado Access may ultimately pay more or less than the posted compensation range. The salary offered to the selected candidate will be determined based on factors such as the qualifications of the selected candidate, departmental budget availability, internal salary equity considerations, and available market information, but not based on a candidate’s sex or any other protected status. In addition to being part of a mission driven organization serving our community, as an eligible Colorado Access employee, you’ll receive a generous benefits package, that includes: Medical, dental, vision insurance that starts the first day of the month following start date. Supplemental insurance such as critical illness and accidental injury. Health care and dependent care flexible spending account options. Employer-paid basic life insurance and AD&D (employee, spouse and dependent). Short-term and long-term disability coverage. Voluntary life insurance (employee, spouse, dependent). Paid time off Retirement plan Tuition reimbursement (based on eligibility). Annual bonus program (based on eligibility, requirements and performance). Where you will work: This position will be a hybrid model work environment, a blend of ‘In-Office’ and ‘Remote.’ We are not able to support out of state employees at this time as we continue to serve our members and community in the metro Denver area and across the beautiful state of Colorado. Colorado Access is committed to providing equal opportunities to all people regardless of race, color, national origin, age, sex, genetic information, religion, pregnancy, disability, sexual orientation, veteran status or any other status protected by applicable law. We strive to maintain a work environment that is free from unlawful harassment and discrimination.

Requirements

Bachelor’s degree in healthcare administration, public policy, business, or related field; or an equivalent combination of education and experience.
Minimum of seven years of progressive experience in ACA Individual, Medicaid/Medicare managed care, or health insurance operations.
Five years of supervisory or management experience required.
Strong understanding of healthcare systems, payer/provider relationships, and exchange operational workflows.
Demonstrates support for the company’s mission, vision and values.
Position requires excellent written and verbal communication skills.
Must be proficient in Microsoft office applications (Word, Excel, PowerPoint, Outlook, SharePoint) with ability to work with a variety of project management tools.
May be required to manage multiple priorities and projects with tight deadlines.
Deep understanding of ACA Exchange dynamics and government program operations.
Experience in high-growth environments and managing remote or hybrid teams.
Ability to translate strategic goals into measurable operational initiatives.
Proven ability to manage multiple priorities and deliver results in a fast-paced, evolving environment.
A valid driver's license and proof of current auto insurance will be required for any position requiring driving.

Nice To Haves

Master’s degree preferred.
Experience with CRM systems, quoting tools, and automation platforms is a plus.
Excellent analytical, organizational, and problem-solving skills.

Responsibilities

Provides strategic direction and oversees the management and maintenance of department deliverables striving for operational excellence (productivity, quality, SLAs, customer experience of services provided, etc.).
Builds high performing teams with vision, leadership, goals and metrics.
Serves as a role model for team members; takes action and inspires team members to embrace and implement culture initiatives.
Provides awareness to staff how their work impacts other departments, programs and the enterprise.
Encourages collaboration and holds team members accountable for achieving outstanding results.
Responsible for all management functions including: hiring, training, planning and directing work, coaching and staff development, managing and evaluating performance, recognizing and rewarding employees; corrective action procedures and practices, addressing complaints and resolving problems.
Develops and manages the department budget.
Works closely with Directors across the organization to make tactical and operational decisions that advance company strategies and goals and collaborates to deliver on company-wide deliverables/requirements.
Oversees/leads departmental projects and continuous improvement initiatives; may lead cross functional teams.
Develops and implements department policies and procedures to ensure compliance with federal, state, local and company policies, rules and regulations.
The Director of Exchange Operations works collaboratively with company operations, functional areas, other lines of business, and external vendors to identify opportunities for process improvement to drive compliance and efficiency
Facilitates transparent communication around objectives and performance between Exchange Segment, Enterprise functions and local health plan Operations
Proactively develops, tracks, and reports performance relative to Marketplace compliance requirements, key performance targets and/or associated service level agreements to Exchange Segment leadership
Quickly escalates performance issues to the Exchange Segment leader and works collaboratively to develop action plans to mitigate
Works collaboratively with corporate business owners, local health plans and the Exchange Segment to identify best practices and opportunities for process improvement to drive compliance and efficiency
Develops strategies and tactics in partnership with Health Plan Service Operations to mitigate any performance issues to ensure established service levels are met (i.e. claims accuracy, G&A timeliness, etc.)
Directs analytical activities to identify trends and potential opportunities for root cause analysis with those Corporate Operations functions that may impact the functionality of Marketplace Operations
Closely partners with Compliance and Internal Audit to identify risk areas and ensure appropriate oversight and closure of internal and external corrective action plans
Ensure adherence to federal, state, and local ACA regulations including CMS, HIPAA, and other relevant standards.
Partner with compliance officers to maintain audit readiness and contractual obligations.
Implement quality assurance protocols and performance metrics.
Partners with project management/implementation leader to create and execute on plans for risk mitigation and process improvement.
Provides oversight for provider relations operations to support the Account Executive function.
Other operational duties as assigned
Lead and mentor a high-performing team across operational functions.
Manage vendor relationships to ensure service quality and cost-effectiveness.

Benefits

PTO
floating holidays
nine company paid holidays
a hybrid work environment
an Employee Assistance Program
401K
Medical, dental, vision insurance that starts the first day of the month following start date.
Supplemental insurance such as critical illness and accidental injury.
Health care and dependent care flexible spending account options.
Employer-paid basic life insurance and AD&D (employee, spouse and dependent).
Short-term and long-term disability coverage.
Voluntary life insurance (employee, spouse, dependent).
Paid time off
Retirement plan
Tuition reimbursement (based on eligibility).
Annual bonus program (based on eligibility, requirements and performance).