Director of Out of Network Solutions

Claritev • New York, NY

7d

About The Position

This position is responsible for planning, directing, and coordinating all aspects of the department to ensure savings preservation and growth, service of all assigned business clients, and the effective communication of the Company's solutions to existing and prospective business partners. This job is responsible for providing the type of leadership, management, and vision necessary to achieve short and long-range business goals and to grow the business unit as well as ensuring operating efficiency. The Director is responsible for directing all facets of the department including staffing, goal setting, budget compliance, product evaluation and enhancement, and policies/procedures to ensure smooth and efficient operations. This job is also responsible for strategic planning and budget decisions.

Requirements

• Minimum Bachelor's degree in healthcare, business, marketing, or related field preferred
• Minimum 7 years experience in the healthcare industry with a minimum of 4 years in a leadership role with people management responsibilities.
• State licensure certification, including NY Health and/or P&C State Adjustor license, may be required. If hired without certification, certification must be obtained, and maintained thereafter, within six months of notification.
• Knowledge of provider billing and collection practices.
• Knowledge of effective negotiations principles.
• Knowledge of commonly used medical coding systems.
• Knowledge of commonly used medical data resources.
• Knowledge of HCFA-1500 and UB-92 medical claim forms.
• Knowledge of Worker's Comp, Auto Medicare, and Government sponsored programs (such as Medicare or Medicaid).
• Communication (verbal and written), managerial, interpersonal, organizational, time management, customer service/sales, problem solving, leadership, strategic, analytical, tactical and execution skills.
• Ability to prioritize and manage time.
• Ability to manage various teams.
• Ability to make decisions using limited or incomplete data.
• Ability to manage multiple projects at the same time.
• Ability to use software, hardware, and peripherals related to job responsibilities, including advanced proficiency with MS Office
• Ability to travel with minimal notice.

Responsibilities

• Direct management of performance to ensure competent staff delivers quality results. This includes training, mentoring, motivating, and overseeing staff performance.
• Develop, implement, and manage both short and long term goals, objectives, policies, and procedures based on current and future trends. Stay abreast of industry and/or customer changes and communicate as appropriate.
• Compile, analyze, and report on trends to include performance improvement initiatives and exceptional client delivery.
• Oversight and development of operational relationships and performance for both client and provider.
• Review referral trends on a monthly basis referral trends to identify opportunities for performance improvement and operational efficiencies.
• Manage departmental and team budgets including expenses, cost containment, and profitability.
• Provide direction and guidance to other levels of management, through delivery of instructions and direction to staff on individual cases and the creation and distribution of goals and standards to subordinates regularly.
• Act as a subject matter expert internally for the Team and other departments within the Company.
• Select, develop, and evaluate staff to ensure the efficient operation of department.
• Collaborate, coordinate, and communicate across disciplines and departments.
• Ensure compliance with HIPAA regulations and requirements.
• Demonstrate Company's Core Competencies and values held within.
• The position responsibilities outlined above are in no way to be construed as all encompassing. Other duties, responsibilities, and qualifications may be required and/or assigned, as necessary.

What This Job Offers

• Job Type: Full-time
• Career Level: Director