Director Billing and Funding

Company :

Job Description : 

JOB SUMMARY

This job is responsible for leading funding and billing operations for 3rd party administration, individual and business partner functions.  This position is responsible for motivating and cultivating a team to provide excellent service allowing for a consumer centric approach balanced with a cost competitive structure to achieve opportunities for additional business.  Assess systems, processes and people and make recommendations.  Define business requirements for software programs used to load, maintain, or transmit information.  Responsible for delegation oversight for subcontractors as well as communicating strategic direction and business requirements identification and post payment recoveries.  Review, document, and communicate software requirements to various vendors to ensure that both internal and external systems perform as required.  Work with multiple external entities to ensure that the vendor's eligibility data is accurate. Provide oversight and direction of the outsourced IS production center for each product line. 

ESSENTIAL RESPONSIBILITIES

• Provide leadership and oversight of management for service operations.  Participate in the formulation and execution of the division’s service operations strategy and vision.
• Establish, monitor and work with team to continuously improve on all aspects of funding & billing operations.  Direct the daily production activities of team members to deliver accurate, timely and efficient service to customers.  Ensures accurate and timely updates to membership records.
• Ensure all operational processes are in compliance with established quality standards, government and industry regulations, and client requirements.  Accountable for CMS required reporting and operating a CMS regulated business in compliance with Medicare C&D regulations. 
• Work closely with other management areas to ensure operational consistency within the organization and all lines of business.  Provides direction, feedback and final approval on the setup of various systems to allow for accurate membership reporting and reconciliation. 
• Ensure high quality employees are hired for team and provide coaching, mentoring, and leadership to direct reports and team.
• Provide significant input and direction to the development of future operational capabilities by evaluating, investigating and recommending newly defined systems, process and techniques. 
• Direct and ensure that all budget guidelines are met.  
• Responsible for all aspects of the systems and processes to operate Plan Partner's business as well the membership data conversion, coordination with corporate systems, branding compliance for government required mailings, Service Level Agreements adherence and reporting, managing staffing in accordance with pricing model provided to Plan Partner and regulatory compliance.
• Other duties as assigned or requested.

QUALIFICATIONS

Minimum

• Bachelor’s degree or relevant experience and/or education as determined by the company in lieu of bachelor's degree
• 7 years in large operations environment
• 7 years with insurance products principles, industry practices, and processes

Preferred

• Master’s Degree
• 5 years of insurance product knowledge
• 5 years in workforce development and resource management
• 3 years with marketing or selling services for operational capabilities
• 3 years with project management

SKILLS

• Experience to effectively manage, direct, and motivate staff.
• Demonstrated track record of operational effectiveness.
• Strategic thinking and planning.
• Must be willing to travel to meet with clients, attend conferences as well as assist Sales with site visits to potential clients.
• Financial and budget/expense management experience.
• Ability to handle multiple priorities and the ability to identify, analyze and solve problems independently.
• Strong organizational and analytical skills Ability to interpret and understand complex government regulations.
• Comprehensive knowledge of Medicare regulations, law and coverage issues.

Language (Other than English):

None

Travel Requirement:

0% - 25%

PHYSICAL, MENTAL DEMANDS and WORKING CONDITIONS

Position Type

Office-based

Teaches / trains others regularly

Occasionally

Travel regularly from the office to various work sites or from site-to-site