Vice President Health Plan Claims and Operations
Company: Mission Regional Medical center
Location: Ontario
Posted on: July 30, 2022
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Job Description:
Overview
This is an onsite position based out of our Corporate office in
Ontario. However, there is an opportunity for a hybrid
schedule.
Responsibilities
The Vice President of Health Plan Claims and Operations is
responsible for the development and execution of Claim Operations
strategies, end-to-end Claim process automation, optimization and
management, identifying and leveraging technology and data to
improve the quality and minimize process cost of Claims for all
Prime Healthcare's self-insured Employee Health Plans. Through
in-depth audit and review of Claims data, the VP will identify
financial savings across all aspects of the Employee Health
Plans.
The VP of Health Plan Claims and Operations will provide strategic
leadership and development of the Claims Department and its
employees, as well as collaborate with Network Development,
Provider Affiliation and Member Relations, Contracting, and
Benefits Administration to ensure data integrity and to drive
financial and operational value across Employee Health Plans to
maximize benefit coverage while containing cost.
The VP of Health Plan Claims and Operations will partner with local
C-Suites and Hospital Administration to execute goals and plans of
the Employee Health Plans. Through inter-professional
collaboration, The VP will ensure that TPA and Health Plan are
notified in a timely fashion of any changes in process or
procedures which would impact their functions.
#LI-RK1
Qualifications
Required qualifications:
Master's Degree in Business Management, Healthcare Administration,
or other relevant fields. A minimum of seven (7) to ten (10) years
prior work experience in Claims Operations and Health Plan
Strategy, in a Managed Care, Self-Funded or hospital setting is
required. Analytical skills with emphasis on generation and
utilization of data to drive operational and financial performance.
Ability to work in a complex, rapidly evolving environment with
multiple internal and external entities and boundaries. Strong
interpersonal skills, problem solving and project/time management
essential. Ability to develop presentations to all levels using
Microsoft Office applications. Strong knowledge of medical coding
(ICD-10, HCPCs/CPT, etc.)
Preferred qualifications:
Certified Professional Coding Certification, AIC, ARM, or
equivalent. Familiarity with multiple Business Intelligence
software systems and daily usage of at least one.
We are an Equal Opportunity/ Affirmative Action Employer and do not
discriminate against applicants due to veteran status, disability,
race, gender, gender identity, sexual orientation or other
protected characteristics. If you need special accommodation for
the application process, please contact Human Resources. EEO is the
Law:
https://www.eeoc.gov/sites/default/files/migrated_files/employers/poster_screen_reader_optimized.pdf
Keywords: Mission Regional Medical center, Ontario , Vice President Health Plan Claims and Operations, Healthcare , Ontario, California
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