Director Health Plan Administrative Operations Job Listing at MedStar Medical Group in Baltimore, MD (Job ID req41948)

Description

Reporting directly to the Vice President/COO of MedStar Family Choice Health Plan Operations, the Director will develop and implement a strategy to expand and increase E2E health plan administrative operations performance and oversight in collaboration with MedStar Family Choice and Strategic Partner leadership. This role will support enrollment and market expansion aspirations through the delivery of efficient and effective service delivery, enabling technology, collaborative relationships and demonstrated results to meet the healthcare needs of the MedStar Family Choice membership and communities it serves. Supervises and directs the activities of various levels of assigned personnel using both professional and supervisory discretion and independent judgment for claims, service, benefit configuration, new member enrollment, encounter data integrity, provider data integrity and vendor performance oversight (in partnership with Director of Vendor Contracting team). The objective of this role is to provide end-to-end health plan operations subject matter expertise to ensure optimal performance and efficiencies, reduce operating costs, foster accountability and excellence, create a culture of collaboration, and increase new member enrollment and retention.
Education

• Bachelor's degree Health Care Administration, Public Health or related field required
• Master's degree Health Care Administration, Public Health or related field preferred

• 5-7 years Experience in a health care setting with preference given to Medicaid and Medicare Plans required
• 5-7 years Leadership experience in a Senior Manager or Director role preferred

• Deep experience with specialized provider types, such as behavioral health is preferred as identified by the health plan (MFC DC or MFC MD).
• Strong working knowledge of health care and provide billing regulations related to payer reimbursement policies, specifically with CMS sponsored plans.
• Must possess excellent organizational skills, including the ability to prioritize multiple tasks and perform them accurately and simultaneously.
• Ability to work with minimal supervision, guidance and direction.
• Must be proficient with MS Office (Word, Excel, PowerPoint and Outlook).
• Proficient knowledge of Medicaid, Medicare and other third party payer requirements pertaining to E2E functions including claims, service, enrollment, documentation, coding, billing and reimbursement.
• Excellent verbal and written communication skills.
• Maintain confidentiality and comply with Health Insurance Portability and Accountability Act (HIPAA).
• Ability to establish and maintain positive and effective work relationships with members, providers, vendors and co-workers
• Demonstrated knowledge of and skill in data collection, analysis and/or interpretation of provider claims data, enrollment data and coding and configuration methodologies.