Vice President of Operations

Regal Medical Group•Los Angeles, CA

23h•$160,000 - $180,000•Onsite

About The Position

The Vice President of Operations will direct, empower, and lead operational departments including Claims, Customer Service, Human Resources, and Facilities/Mailroom operations to ensure adherence to all contractual and regulatory requirements. This role involves administrative functions such as departmental budgets, financial planning, and staff projections, overseeing training and resource materials, and developing policies and procedures. The position supports company goals and strategy, interprets contracts and claims for payment and benefit determination, and creates reports for oversight and compliance. The VP will represent the Claims Department in various meetings, oversee audits, and keep senior executive staff informed of operational activities. Responsibilities also include meeting departmental goals for production, compliance, and accuracy, evaluating staff, and performing other duties as assigned by management.

Requirements

Extensive experience in managing large claims staff, with multiple health plans, products and regions.
Excellent professional and hospital claims adjudication skills.
Full working knowledge of TPL, COB, PPO, POS, HMO, ASO and Indemnity products.
Knowledge of DRG Grouper.
Knowledge of CPT-4, HCPCS, Revenue and ICD-9 coding.
Extensive knowledge of Medicare, and Medi-Cal.
Knowledge of contracts and contractual interpretations for payment and benefit issues.
Strong knowledge of Microsoft Windows environment.
Working knowledge of Microsoft Excel and Word.
Excellent written and verbal communication skills.
Strong organizational and leadership skills.
Experience developing and producing management reports.

Nice To Haves

EZ-Cap experience helpful

Responsibilities

Coordinate the development of, and oversee the execution of Claims, Customer Service, Human Resources and Facility/Mailroom operations to ensure adherence to all contractual and regulatory requirements.
Perform the administrative functions such as departmental budgets, financial planning and staff projections.
Oversee the training and resource material as needed.
Oversee the development of Policy and Procedures for Department as needed.
Support company activities such as company goals/strategy and management meetings as required.
Interpret the contracts and claims for the appropriate payment and benefit determination.
Create and run reports for department oversight, and compliance issues.
Represent the Claims Department in Operation, Committee and health plan Meetings.
Oversee the Health Plan and regulatory audits, and represent Claims in all audit processes.
Keep senior executive staff informed of operational activities.
Develop reports for internal and external reporting needs.
Responsible for meeting or exceeding established departmental goals such as production standards, compliance, and claims accuracy.
Evaluate staff as part of interview or review process and make recommendations for employee hiring, firing, and/or retention.
All other duties as assigned by management.