Director – National Operations

🕒 il y a 20 jours

🌽 Illinois – Distant

🌽 Illinois – Remote

💵 $160 000 - $175 000 / an

⏰ Temps Plein

🔴 Expert

⚙️ Opérations

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TAG - The Aspen Group

Site WebLinkedInTous les Emplois

10 000+ employés

🏥 Santé

⚕️ Assurance santé

Healthcare • Healthcare Insurance

TAG - The Aspen Group est une entreprise qui vise à révolutionner le secteur des soins de santé en améliorant la prise en charge et l'expérience des patients dans divers domaines, y compris la dentisterie et les soins médicaux sans rendez-vous. Le groupe soutient ses marques pour éliminer les obstacles aux soins dentaires, favoriser le développement professionnel et apporter des contributions significatives à l'industrie de la santé. Avec un engagement à responsabiliser ses équipes, The Aspen Group vise à restaurer les sourires et la confiance, rendant les soins de santé accessibles et bienveillants.

Description

• Develops and maintains effective working relationships with insurance company contacts for assigned national plans. • Oversee the entire operational relationship with assigned national plans across Aspen Dental and WellNow, 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 national plans, driving continued results with plan partners. • Ensures audits occur monthly for national plans to confirm accurate network information and drive quick resolution of 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 for national plans. • Monitors contract performance and other provisions to assure compliance, identify problem areas, and resolve disputes. • Resolves escalated contract issues generated by operational department heads. • Works collaboratively with payors and Aspen Department Leadership (Legal/Compliance, Finance, Centralized Billing, and IT) on strategic business development efforts to ensure geographic reach, plan and service types, and optimal reimbursement rates.

🎯 Exigences

• 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 experience in a payor or health care setting, with experience across multiple brands or business lines preferred • Broad knowledge of healthcare insurance, healthcare billing and reimbursement, administration, systems, practices and principles (i.e. Medicare, Medicare Advantage, and Commercial) • Knowledge and ability to effectively use negotiation techniques and practices to advocate for providers • 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

🏖️ Avantages

• paid time off • health • dental • vision • 401(k) savings plan with match