Medicaid Business Operations Program Director
About The Position
The Director of Fiscal Agent Operations leads fiscal agent operations for the NCMMIS program, which built and operates NCTracks, a multi-payer claims adjudication system for the State of North Carolina and serves as the Medicaid fiscal agent for NC DHHS. The position is second in command for the NCMMIS program and assumes Executive Account Director responsibilities when that executive is away or unavailable. The Director is the senior subject matter expert on the NC Medicaid and Health Choice programs, supporting subordinate fiscal agent operations areas and the Applications Services Group as needed in developing and validating business requirements for system enhancements. The role is accountable for the financial performance of its reporting areas and actively participates in program planning, budgeting, and financial optimization. The position helps ensure successful program operations, customer objective achievement, monthly service-level commitments, adaptation to evolving customer needs through collaboration with customer executives and the contractual change management process, and handling performance escalations from program stakeholders. It oversees Claims, Prior Authorization, Provider Enrollment, Call Center, Finance, Medical, Pharmacy, and Dental functions. The role is hybrid, with 40 scheduled weekly hours and less than 10% travel required.
Requirements
- Master’s degree or an equivalent combination of education and experience.
- Fourteen or more years of experience related to health care administrative management.
- Ten or more years of experience in State Medicaid.
- More than five years of leadership experience in a large organization.
- Experience interacting with customers to help solve their business challenges.
- Knowledge of Medicaid and Health Choice programs; North Carolina experience is preferred.
- PMI PMP certification or commitment to achieve certification.
- Strong human relations skills to select, develop, coach, and mentor employees.
- Skills in building high-performance teams, collaboration, communication, leadership, and provider enrollment.
Nice To Haves
- Knowledge of Medicaid and Health Choice programs, preferably in North Carolina.
Responsibilities
- Lead fiscal agent operations functions for the NCMMIS program.
- Help ensure successful program operations, meet customer objectives, and achieve monthly service-level commitments.
- Work with customer executives to adapt the program to evolving customer needs through the contractual change management process.
- Handle performance escalations from program stakeholders.
- Serve as second in command for the NCMMIS program and assume Executive Account Director responsibilities when the EAD is away or unavailable.
- Act as the senior subject matter expert on NC Medicaid and Health Choice programs, providing support to subordinate fiscal agent operations areas and the Applications Services Group.
- Support development and validation of business requirements for system enhancements.
- Manage the financial performance of reporting areas and actively participate in program planning, budgeting, and financial optimization.
- Lead direct reports overseeing Claims, Prior Authorization, Provider Enrollment, Call Center, Finance, Medical, Pharmacy, and Dental functions.
- Select, develop, coach, and mentor employees.
Benefits
- 401(k) with company match.
- Comprehensive health and wellness packages, including medical plan options, some with Health Savings Accounts.
- Dental plan options.
- Vision plan.
- Paid education and certifications.
- Professional growth opportunities and an internal mobility team.
- Paid vacation, sick and personal time, and holidays.
- Paid parental leave, including a paid family leave program of up to 160 hours in a rolling 12-month period for eligible employees.
- Disability benefits, life insurance, accidental death and dismemberment insurance, personal accident insurance, critical illness insurance, and business travel and accident insurance.
- Full flex work weeks where possible.
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What This Job Offers
Job Type
Full-time
Career Level
Director
