Director Regional Operations + Process Assurance

Aspen Dental•NY - Remote, NY

3d•$160,000 - $175,000•Remote

About The Position

The Aspen Group (TAG) is seeking a Director of Regional Operations and Process Assurance to join their Payor Strategy Team. This role reports to the Vice President, Payor Strategy, and will oversee a team of 3-5 individuals. The position focuses on supporting regional operations for Aspen Dental, managing local plan relationships, and owning the process assurance function for the department. This includes conducting proactive audits, managing standard operating procedures, and ensuring the team's work is accurate and roles are clear. TAG is a large retail healthcare business support organization that partners with independent practice owners and clinicians across dental care, urgent care, medical aesthetics, and animal health.

Requirements

Bachelor's degree
Highly proactive, with strong critical thinking skills and the ability to architect solutions rather than just flag problems
Direct experience with insurance and provider contracting required. Must have been personally involved in managed care contracting or contract strategy work, not just adjacent to it
Strong exposure to healthcare operations required. Dental experience is not required; medical or other clinical operations experience is a fit
7 or more years of progressively responsible management or supervisory level managed care contracting or provider network operations experience in a payor or health care setting, including experience leading audit, quality assurance, or process improvement functions
Broad knowledge of healthcare insurance, healthcare billing and reimbursement, administration, systems, practices and principles (i.e. Medicare, Medicare Advantage, and Commercial)
Experience building and enforcing standard operating procedures and audit processes
Excellent verbal and written communication
Excellent time management, prioritization, and organizational skills
Detail oriented with a strong level of analytical and problem-solving skills
Proficient use of Microsoft Office Suite

Responsibilities

Develops and maintains effective working relationships with insurance company contacts for assigned regional plans.
Oversees the entire operational relationship with assigned regional plans, including grievances, rate validation, educational outreach, and any other operational issue that affects the plan.
Proactively looks for ways to improve support to Aspen offices, streamline processes with plans, and increase transparency and issue resolution for offices and owners.
Oversees and participates in Joint Operating Committees (JOCs) for assigned regional plans, driving continued results with plan partners.
Owns and maintains data sources to ensure network and contract processes remain accurate.
Manages and updates standard operating procedures.
Proactively audits data monthly to confirm accurate network information and quickly resolve contract data issues.
Identifies trends across markets and partners with department heads to build educational resources for the plans.
Oversees the distribution of field education and company initiatives to the field as needed.
Acts as an expert resource on escalated contractual and compliance issues within the region.
Monitors contract performance and other provisions to assure compliance, identify problem areas, and resolve disputes.
Resolves escalated contract issues generated by operational department heads.
Trains, supports, and develops the team to meet department metrics and expectations.
Ensures the team delivers first-class customer service to owners.
Efficiently resolves plan-related issues raised by owners and the field.
Creates education and resources for the field so they have what they need.
Coaches the team on grievance handling and root cause identification to prevent repeat issues.