Job Description

Position Purpose:  The Vice President, Health Plan Operations works to improve provider and member satisfaction by enhancing the workflow and processes within Reimbursement Services as well as how those workflow and processes may be affected by other Departments’ workflows and processes within Steward Health Choice.

 

Responsibilities:

·         Assures all departments within Steward Health Choice are operating efficiently and effectively

·         Develops and implements policies and procedures to ensure appropriate work is completed in a  timely and accurate manner that maximizes staff productivity

·         Ensures policies and procedures are documented according to organizational protocols; this is inclusive of all training materials, while ensuring positive outcomes and the highest levels of service to our members and providers

·         Acts as Health Choice Arizona Product Owner; is responsible for reporting to regulator(s), ensuring appropriate procedures and reporting are established in a timely and accurate manner

·         Identifies, develops and implements opportunities for streamlining and improving processes

·         Leads, attends and contributes to appropriate management meetings

·         Sets example of proper behavior and accountability to employees and serve as a role model for what is expected of a Steward Health Choice employee while maintaining excellence in quality and performance in all aspects of their work

·         Collaborates with Internal Audit for process development

·         Completes or ensures the completion of timely and accurate regulator reports and responses to regulator inquiries as required by contract and law

·         Ensures informed of changes in government policies and regulations pertaining to the Health Plan

·         Continuously reviews departmental processes for procedural improvements and streamlining operations. Introduces technological interventions that can and do benefit the operation

·         Proactively and transparently communicates to leaders and openly communicates with direct report

·         Assures staff is trained in measuring, assessing, and improving performance and has the knowledge, training, support, tools and guidance required to effectively execute their roles

 

Equal Opportunity Employer Minorities/Women/Veterans/Disabled



Qualifications

Education:   

·         Bachelor’s Degree in Health Services Administration or related science or administrative field preferred

 

Years of Experience:  

·         At least 10 years of experience in the health care industry in a leadership role, preferably within the health plan space

 

Specialized Knowledge/Skills:  

·         Medical terminology

·         CPT, HCPCS, ASA and ICD-10 coding schemes

·         Claims billing- 1500s, UB92s and dental

·         Managed health plan functions and responsibilities

·         Medicaid and Medicare requirements and procedures

·         Provider contract and fee schedules

·         Plan benefits

·         Encounter submission

·         Proficient in Excel and Word applications

·         Claims processing systems

·         Excellent organizational skills

·         Solid organizational skills

·         Proven leadership skills

·         Strong negotiation skills

 

Abilities:

·         Ability to logically analyze and solve problems

·         Attention to detail and ability to multi-task

·         Ability to create innovative ideas

·         Ability to establish and maintain good communications with all levels of interpersonal relations

·         Ability to implement and follow through

Application Instructions

To apply directly to Steward Health Care, please click the link below. Another window will open and allow you to apply directly online.

Apply Online