Director, Regional Operations – Process Assurance

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🔥 14 hours ago

🗽 New York – Remote

🗽 New York – Remote

💵 $160k - $175k / year

⏰ Full Time

🔴 Lead

⚙️ Operations

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ASPEN DENTAL GROUP, PC

WebsiteLinkedInAll Job Openings

1 - 10 employees

Founded 1998

⚕️ Healthcare Insurance

Healthcare Insurance

Aspen Dental Group, PC is a dental care organization dedicated to providing comprehensive dental services to patients while supporting dental professionals in their careers. The company emphasizes the importance of bringing better care to more people by investing in employee success through training, support, and a proven practice model. Aspen Dental's approach includes offering industry-leading pay, tuition reimbursement, and opportunities for career advancement, with a commitment to diversity and community impact. With over 25 years of experience, Aspen Dental also contributes to charitable efforts by donating free dental care and focuses on providing a collaborative and inclusive workplace.

📋 Description

• Develops and maintains effective working relationships with insurance company contacts for assigned regional plans. • Oversee the entire operational relationship with assigned regional plans, including grievances, rate validation, educational outreach, and any other operational issue that affects the plan. • Proactively looks for ways to improve support to Aspen offices, streamline processes with plans, and increase transparency and issue resolution for offices and owners. • Oversee and participate in Joint Operating Committees (JOCs) for assigned regional plans, driving continued results with plan partners. • Owns and maintains data sources to ensure network and contract processes remain accurate. • Manages and updates standard operating procedures. • Proactively audits data monthly to confirm accurate network information and quickly resolve contract data issues. • Identifies trends across markets and partners with department heads to build educational resources for the plans. • Oversee the distribution of field education and company initiatives to the field as needed. • Acts as an expert resource on escalated contractual and compliance issues within the region. • Monitors contract performance and other provisions to assure compliance, identify problem areas, and resolve disputes. • Resolves escalated contract issues generated by operational department heads. • Other duties as assigned. • Train, support, and develop the team to meet department metrics and expectations. • Ensure the team delivers first class customer service to owners. • Efficiently resolves plan related issues raised by owners and the field. • Creates education and resources for the field so they have what they need. • Coaches the team on grievance handling and root cause identification to prevent repeat issues.

🎯 Requirements

• Bachelor's degree • Highly proactive, with strong critical thinking skills and the ability to architect solutions rather than just flag problems • Direct experience with insurance and provider contracting required. • Must have been personally involved in managed care contracting or contract strategy work, not just adjacent to it • Strong exposure to healthcare operations required. • Dental experience is not required; medical or other clinical operations experience is a fit • 7 or more years of progressively responsible management or supervisory level managed care contracting or provider network operations experience in a payor or health care setting, including experience leading audit, quality assurance, or process improvement functions • Broad knowledge of healthcare insurance, healthcare billing and reimbursement, administration, systems, practices and principles (i.e. Medicare, Medicare Advantage, and Commercial) • Experience building and enforcing standard operating procedures and audit processes • Excellent verbal and written communication • Excellent time management, prioritization, and organizational skills • Detail oriented with a strong level of analytical and problem-solving skills • Proficient use of Microsoft Office Suite

🏖️ Benefits

• A generous benefits package that includes paid time off • health • dental • vision • 401(k) savings plan with match