Senior Director of Claims and Vendor Management

AMIDA CARE INC.•New York, NY

About The Position

Amida Care, the largest Medicaid HIV Special Needs Plan in NY, delivers a uniquely effective care model that has become a true benchmark for innovation, engagement and member health outcomes. Our mission is to provide access to comprehensive care and coordinated services that facilitate positive health outcomes and general well-being for our members. This true integrative care model addresses psychosocial, housing, behavioral and medical services directly evolving around the needs of each member. We are a community of individuals from diverse peoples who work together to actively foster a fair, equitable, inclusive environment where all employees receive an invitation to belong. We are actively seeking a highly motivated, innovative and experienced individual to join our team as the Senior Director of Claims and Vendor Management. Compensation will be commensurate with experience. In collaboration with and under the direction of the Vice President of Operations, this role is responsible for managing all hands-on operational aspects of the Claims and Vendor Management Teams and will assist the Vice President of Operations in successfully meeting the organization’s goals. This role is responsible for the overall direction and administration of key operational metrics and regulatory and compliance programs and services provided by the health plan.

Requirements

Minimum of a bachelor’s degree in business, Health Services Administration or related field; Master preferred or ten (10) - plus years’ progressive healthcare experience in managed care industry or related field.
Five to seven (5-7) years’ experience with New York State Medicaid health plans including five (5) at a senior level.
Working knowledge Medicaid regulatory reporting (i.e., MMCOR/SNPOR) by New York State Department of Health and CMS.
Strong analytical, innovative, and critical thinking skills.
Collaborative and inclusive leadership style. Open to feedback, new ideas and approaches.
Exceptional interpersonal and verbal/written communication skills.
Strong computer skills, including MS Office (EXCEL, Word, Power Point).
Demonstrate understanding and sensitivity to multi-cultural values, beliefs, and attitudes of both internal and external contacts.
Demonstrate appropriate behaviors in accordance with the organization’s vision, mission, and values.

Nice To Haves

Master’s degree

Responsibilities

Responsible for the day-to-day operations for claims and vendor management, including supervision and oversight of claims and vendor management leaders and external vendors.
Provide leadership to ensure the company has the proper operational controls, administrative and reporting procedures, and people systems in place to effectively grow the organization and to ensure financial strength and operating efficiency.
Maintain responsibility for the continuous improvement of claims processing procedures by resolving claims processing challenges by trending and conducting root cause analysis utilizing best practices.
Ensure departmental compliance with contractual, regulatory, and corporate requirements, guidelines, and goals including turnaround times, timely submissions and reporting.
Lead the development and implementation of policies, processes, and best practices for managing vendor relationships across the organization.
Establish and manage a robust vendor governance framework, including vendor risk assessment, due diligence, contract negotiation, and performance management.
Oversee implementation / project management both contractually and operationally for new vendors and third-party software outside of IT.
Ability to develop claims and vendor management performance metrics and KPIs.
Responsible for the hiring and retention of quality staff and the on-going planning, monitoring, training, coaching, evaluation, and appraisal.
Oversee vendor integration of new product lines.
Analyze and trend claims related data to identify inefficiencies and implement process improvements.
Other duties as assigned.