Position's focus is on strategy, policy, operational planning and execution of work processes for the company and/or major area(s) of responsibility. Position provides oversight for new business/expansion in markets for operations and includes leadership responsibility for end-to-end tesing, documenting root cause and implemeting solutions to improve financial/payment accuracy, increasing system adjudication rates, creating SATs for manual processing and compliance enforcement within the operation.
Reports to: COO
Dept.: Network Development
Location: Atlanta, GA
- Manages and develops direct reports who include directors and/or managers
- Defines and directs activities of area(s) of responsibility
- Sets direction, allocates, and reallocates utilization of resources as required
- Determines operational tactics to implement policies and strategies
- Recommends and implements work processes to substantially improve performance
- Sets overall goals, performance standards, and priorities for one or more functions and manages resources to goals and budget
- With approval from members of executive management, establishes and monitors budget for cost centers within his/her span of control.
- Market communication on RPPC updates.
- P&P development for Regulatory and Operational compliance.
- Lead on key projects/initiatives for the provider operations
- Responsible for collaborating with IT Team to improve efficiencies via technical solutions
- Required A Bachelor's Degree in a related field
- Required or equivalent work experience
- Required 10 years of experience in the areas of root cause analysis, quality improvements, and in managed care/healthcare industry.
- Advanced Demonstrated leadership skills
- Advanced Demonstrated ability to deal with confidential information
- Advanced Demonstrated written communication skills
- Advanced Demonstrated interpersonal/verbal communication skills
- Advanced Ability to multi-task
- Advanced Ability to work in a fast paced environment with changing priorities
- Advanced Demonstrated organizational skills
- Advanced Ability to implement process improvements Ability to remain calm under pressure
- Intermediate Other Ability to move about the office
- Intermediate Other Provide proactive approach and support to emerging business activities established to remain competitive in the marketplace
- Intermediate Other Solid understanding of managed care and its place in the health care industry.
- Advanced Other Strong understanding of the various cross-functional business processes within a health plan, and how they work together to produce desirable results for the plan as a whole.
- Intermediate Other In-depth functional knowledge, broad based multi-functional knowledge
- Intermediate Other In-depth understanding of company and customer
- Required Intermediate Microsoft Word
- Required Intermediate Microsoft Excel
- Required Intermediate Other Knowledge of and/or ability to utilize COGNOS for budgetary decisions or review.