Health Insurance Operations Director jobs in West Virginia

As the Director of Operations and Financial Administration within the Clinical Integrated Network, you will be instrumental in overseeing the day-to-day operations of the Network focusing on operational efficiency, financial health, and strategic growth. Additionally, you will be responsible for monitoring and reporting on the financial performance of the Network.

Responsibilities

• Responsible for advancing key objectives by managing the day-to-day operations, including project management, problem resolution and other activities to assist in the facilitation of a successful program. • Work with senior leadership to develop key performance indicators and regular reports to monitor Network performance and progress toward goals. • Perform routine reconciliations of funds received from payers and other revenue sources, ensuring prompt disbursement while maintaining accurate records of reconciliation tasks. Additionally, deliver periodic reports to leadership on reconciliation activities. • Follow established methodologies to calculate earned savings for plan members, utilizing predefined performance metrics and benchmarks. Additionally, ensure timely distribution of funds and periodic reports to leadership. • Analyze data, utilization patterns, and other relevant factors to assess the extent of cost savings achieved by plan members. This involves identifying and defining missed opportunities. • Oversee the financial performance of Network campaigns and deliver insights and recommendations based on monitoring activities. • Support the development and maintenance of the provider roster by aiding in reconciling data from various sources, reporting of provider changes, and ensuring compliance with contractual requirements. • Responsible for the administrative support related to the organization of the payer contracts and value-based documents, including the development and maintenance of contract summaries. • Support leadership in negotiating payment arrangements with commercial payers. • Provide support for the analysis of quality and utilization performance by provider, practice, region, payer and in aggregate. • Provide support for the building, development and maintenance of data models, data automation, dashboards, key performance metrics, and quality reports that support network performance opportunities. • Support health system leadership with special projects and assignments such as operational projects, regulatory submissions, onboarding of new clients, and workflow initiatives. • Accountable for achieving superior customer service. Qualifications: • Demonstrated leadership and management skills, ideally in a business or healthcare setting. • Strong analytical and project management skills and capabilities. • Extensive experience with EMRs and advanced computer skills. • Proven background in the healthcare industry, with a focus on financial and operational management.

Knowledge, Skills & Abilities

Education

• Bachelor's Degree (Required) Bachelor's degree preferably in Finance, Accounting, Health Science, or other related field.

Credentials

Work Schedule: Days

Status: Full Time Regular 1.0

Location: Northgate-400 Association Dr.

Location of Job: US:WV:Charleston

Talent Acquisition Specialist: Anita J. Ferguson anita.ferguson@vandaliahealth.org