Job Summary

JOB SUMMARY

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.

ESSENTIAL DUTIES AND RESPONSIBILITIES

Include the following. Others may be assigned.

1. 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.
2. Helps ensure the achievement of goals by continuously monitoring the professional and facility medical claims operations performance against established development, financial and staffing plans
3. Establishes and maintains effective working relationships with all CVBC departments, clients, and partnerships ensuring that their needs and concerns are addressed promptly and effectively
4. 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
5. 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.
6. Establishes and maintains effective working relationships with all CVBC departments, clients, and partnerships ensuring that their needs and concerns are addressed promptly and effectively
7. 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.
8. 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.
9. 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
10. Attends internal and external meetings/trainings as necessary, manages leadership team, assesses inventory vs. resources and provides overtime and inventory reduction plans when necessary
11. Maintains sensitivity to needs of the various client groups and identified new business opportunities whenever possible.

12. 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;

SUPERVISORY RESPONSIBILITIES

If direct report positions are listed below, the following responsibilities will be performed in accordance with guidelines, policies and procedures and applicable laws. Supervisory responsibilities include interviewing, hiring, and training employees; planning, assigning and directing work; appraising performance; rewarding and disciplining employees; addressing complaints and resolving problems

KNOWLEDGE, SKILLS, ABILITIES

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

• 10 years managed care experience
• 10 years managerial/senior leadership experience
• Proficiency in Microsoft Office suite

Conifer requires its candidates, as applicable and as permitted by law, to obtain and provide confirmation of all required vaccinations and screenings prior to the start of employment. This may include, but is not limited to, the COVID-19 vaccination, influenza vaccination, and/or any future required vaccines and screenings.

EDUCATION / EXPERIENCE

Include minimum education, technical training, and/or experience preferred to perform the job.

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

REQUIRED CERTIFICATIONS/LICENSURE

Include minimum certification required to perform the job.

• Not applicable

PHYSICAL DEMANDS

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

• Must be able to work in sitting position, use computer and answer telephone
• Ability to travel
• Includes ability to walk through hospital-based departments across broad campus settings, including Emergency Department environments

WORK ENVIRONMENT

The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

• Office Work Environment
• Hospital Work Environment
• Approximately 10% travel may be required

TRAVEL

OTHER

As a part of the Tenet and Catholic Health Initiatives family, Conifer Health brings 30 years of healthcare industry expertise to clients in more than 135 local regions nationwide. We help our clients strengthen their financial and clinical performance, serve their communities, and succeed at the business of healthcare. Conifer Health helps organizations transition from volume to value-based care, enhance the consumer and patient healthcare experience and improve quality, cost, and access to healthcare. Are you ready to be part of our solutions? Welcome to the company that gives you the resources and incentives to redefine healthcare services, with a competitive benefits package and leadership to take your career to the next step!

Compensation and Benefit Information

Compensation

• Pay: $133,598 - $200,408 annually. Compensation depends on location, qualifications, and experience.
• Position may be eligible for an Annual Incentive Plan bonus of 10%-25% depending on role level.
• Management level positions may be eligible for sign-on and relocation bonuses.

Benefits

Conifer offers the following benefits, subject to employment status:

• 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.

Employment practices will not be influenced or affected by an applicant’s or employee’s race, color, religion, sex (including pregnancy), national origin, age, disability, genetic information, sexual orientation, gender identity or expression, veteran status or any other legally protected status. Tenet will make reasonable accommodations for qualified individuals with disabilities unless doing so would result in an undue hardship.
Tenet participates in the E-Verify program. Follow the link below for additional information.
E-Verify: http://www.uscis.gov/e-verify
The employment practices of Tenet Healthcare and its companies comply with all applicable laws and regulations.