Director, Provider Network Operations

🔥 13 minutes ago

🏰 Missouri – Remote

🏰 Missouri – Remote

💵 $108.5k - $184.4k / year

⏰ Full Time

🔴 Lead

🌐 Network Operations

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PacificSource Health Plans

WebsiteLinkedInAll Job Openings

1001 - 5000 employees

Founded 1933

⚕️ Healthcare Insurance

💸 Finance

🧘 Wellness

Healthcare Insurance • Finance • Wellness

PacificSource Health Plans is a healthcare provider that offers a range of health insurance solutions, including plans for individuals, families, and employers. Their offerings include Medicare and Medicaid plans, dental coverage, and administrative services for small and large groups. Committed to member care, PacificSource emphasizes customer service and provides various resources for health management, including mental health support and wellness programs.

📋 Description

• Guide strategic initiatives for the Provider Network Operations division, including network setup and maintenance, provider data integrity, provider education and service, contract implementation performance, provider-related claims, provider setup and audits, corrective action plan assessment and closure, and provider directory accuracy improvements. • Collaborate with Provider Reimbursement Insights and Analytics Team to ensure success in meeting objectives. • Develop, direct and execute efforts to meet Credentialing division objectives, ensuring compliance and operational excellence. • Develop and execute strategies for provider education and relationship management to enhance provider collaboration, engagement, and satisfaction within the Provider Relations Team. • Lead initiatives to ensure seamless integration and ongoing operational effectiveness of provider network platforms with legacy and emerging systems. • Collaborate with IT teams and operational leaders to identify interoperability gaps and develop solutions to enhance system compatibility. • Ensure integrated systems support compliance with state, federal, and NCQA standards, as well as organizational policies. • Develop automated workflows and processes that ensure accurate synchronization of data across all platforms and departments. • Guide efforts to improve functionality via the deployment of LEAN methodologies and resources.

🎯 Requirements

• Minimum of 8 years in healthcare operations required • Management experience required • Must have expertise in provider reimbursement methodologies, provider relations, data management and compliance • Experience developing, communicating, and executing strategy in a matrixed organizational structure • Bachelor’s degree in business, health care administration, finance, or related field required • Candidates with an associate’s degree and 2 years of relevant experience, or a high school diploma and 4 years of relevant experience will also be considered

🏖️ Benefits

• Flexible telecommute policy • medical, vision, and dental insurance • incentive program • paid time off and holidays • 401(k) plan • volunteer opportunities • tuition reimbursement and training • life insurance • options such as a flexible spending account