Senior Regional Operations Director

Tenet Executive Search

About The Position

The Senior Director manages the day-to-day professional and facility medical claims on and off shore operations, including the medical claims intake, processing, quality assurance, revenue recovery, and provider/member call center activities in accordance with established plans, standard operating procedures, and legal and regulatory requirements. Reports to Vice President, Financial Risk Management, VBC, and assists in developing, implementing, and monitoring of the professional and facility medical claims operational plans, goals, and objectives. The Senior Director makes all daily operating decisions of the claims operations according to established plans, policies, and standard operating procedures. Refers issues that could severely impact the organization reputation or financial conditions to the Vice President, Financial Risk Management, VBC. Recommends future plans, programs, and changes to the Vice President. Establishes policies for department heads so that decisions on specific daily operational issues can be resolved in an effective manner.

Requirements

10 years managed care experience
10 years managerial/senior leadership experience
Proficiency in Microsoft Office suite
Bachelor’s Degree required

Nice To Haves

Master’s Degree in Health Administration, Business Administration, or Public Health preferred

Responsibilities

Optimizes the CVBC professional and facility claims operations financial and human resources by administering all day-to day professional and facility medical claims operations in a quality and cost conscious manner ensuring that decisions are sound, fair, and consistent with the goals of the organization and in compliance with various national and local statues.
Helps ensure the achievement of goals by continuously monitoring the professional and facility medical claims operations performance against established development, financial and staffing plans
Establishes and maintains effective working relationships with all CVBC departments, clients, and partnerships ensuring that their needs and concerns are addressed promptly and effectively
Ensures the effective management of the professional and facility medical claim operations resources by assisting in the recruiting and retaining highly qualified individuals, establishing and monitoring management development plans and programs for department heads, and communicating expectations on a regular basis. Provides goal-oriented direction to CVBC executive and senior leadership; assists with problem solving as needs arise, and notifies individuals promptly when adjustments or problems are perceived
Ensures that the highest possible quality of care is delivered to clients and their members by continuously monitoring quality assurance plans and procedures and establishing programs to improve quality whenever possible.
Establishes and maintains effective working relationships with all CVBC departments, clients, and partnerships ensuring that their needs and concerns are addressed promptly and effectively
Ensures compliance of all professional and facility claims regardless of department where the claim is pending, Oversees and monitors professional and facility medical claims inventory reports and directs managers with work queues assignments based on staffing and/or volume, and the assessment, identification and distribution of unprocessed work to staff on a first-in first-out basis or other established priorities.
Works collectively with all levels of management and staff to ensure compliance with inventory production and timeliness standards including but not limited to QC, T&C, Eligibility, UM, Compliance, and Operations Departments, Reviews daily operational reports throughout the day to assure compliance, Maintains controls to insure that all claims are processed within regulatory requirements.
Reviews daily production reports to monitor and counsel staff not meeting the established production requirements, Reviews monthly report cards to train and counsel staff that is consistently not meeting quality standards., Identifies training for staff failing to meet established minimum production and quality objectives
Attends internal and external meetings/trainings as necessary, manages leadership team, assesses inventory vs. resources and provides overtime and inventory reduction plans when necessary
Maintains sensitivity to needs of the various client groups and identified new business opportunities whenever possible.
Ensures a high level of morale and esprit de corps among and between the departments within the regional office, and clientele by providing direct, open lines of communications throughout the organization. Maintains a high level of visibility in the organization and actively participates in team-building programs and other employee activities

Benefits

Medical, dental, vision, disability, life, and business travel insurance
Management time off (vacation & sick leave) – min of 12 days per year, accrued accrue at a rate of approximately 1.84 hours per 40 hours worked.
401k with up to 6% employer match
10 paid holidays per year
Health savings accounts, healthcare & dependent flexible spending accounts
Employee Assistance program, Employee discount program
Voluntary benefits include pet insurance, legal insurance, accident and critical illness insurance, long term care, elder & childcare, AD&D, auto & home insurance.
For Colorado employees, Conifer offers paid leave in accordance with Colorado’s Healthy Families and Workplaces Act.

Stand Out From the Crowd

Upload your resume and get instant feedback on how well it matches this job.

Upload and Match Resume