Managing Advisor III Senior Director

4 weeks ago

Los Angeles, California, United States L.A. Care Health Plan Full time

Salary Range: $171, Min.) - $232, Mid.) - $292, Max.)

Established in 1997, L.A. Care Health Plan is an independent public agency created by the state of California to provide health coverage to low-income Los Angeles County residents. We are the nation's largest publicly operated health plan. Serving more than 2 million members, we make sure our members get the right care at the right place at the right time.

Mission: L.A. Care's mission is to provide access to quality health care for Los Angeles County's vulnerable and low-income communities and residents and to support the safety net required to achieve that purpose.

Job Summary

The Managing Advisor III Senior Director, Claims Operations will develop and oversee the implementation of system enhancements to streamline the claims handling process. This position will develop and enhance processes for collecting and maintaining claims data, conducting coverage reviews and evaluations, and providing educational and functional support for the claims and invoicing systems. The Managing Advisor III Senior Director provides leadership in the ongoing development and implementation of processes and protocols that are responsive to organizational needs.

This position will manage costs against budget and drive a culture of high accountability within the claims teams.

This position is responsible for directing all aspects of running an efficient team, including hiring, supervising, coaching, training, disciplining, and motivating direct reports.

Duties

Conducts strategic planning to utilize resources in order to meet current and future departmental and Enterprise-wide goals.

Provide expert guidance and strategic direction to optimize the claims operations within the organization. Address underlying strategic and tactical objectives affecting compliance with internal and governmental policies.

Analyze and evaluate claim processes and procedures, identify trends, patterns, root causes of issues, areas for improvement, and implement solutions to enhance. Develop and implement strategies to streamline operations, process improvements to reduce costs, and enhance productivity, efficiency, accuracy, and customer satisfaction.

Ensure enterprise-wide business functions and processes are effectively and efficiently administered and adapted to meet L.A. Care's strategic and annual goal

Provide leadership and direction on new projects and initiatives. Oversee the quality and integrity of claims data. Monitor key performance indicators (KPIs) to measure the effectiveness of implemented changes and adjust strategies as needed.

Develops and recommends overall policies and procedures s related to claims processing to ensure compliance with regulatory requirements and industry standards. Provide recommendations for policy enhancements based on industry trends and best practices.

Stay informed about regulatory changes and industry developments to ensure compliance and mitigate risks. Responsible for regulatory reporting initiatives.

Conduct peer and quality assurance reviews to ensure processed claims are accurate and in accordance with established guidelines. Oversee the quality and integrity of claims data.

Duties Continued

Collaborate with senior management and cross-functional teams to create and maintain a positive and integrated customer experience to achieve operational objectives. Foster a culture of continuous improvement by promoting best practices and providing guidance on complex claims scenarios.

Collaborate with key stakeholders to achieve productivity targets, customer experience outcomes, and financial goals.

Responsible for the work and related budget of department programs.

Develops goals, objectives and actions plans for assigned staff, which includes full management responsibility for the hiring, performance reviews, salary reviews and disciplinary matters for direct reporting employees.

Perform other duties as assigned.

Education RequiredBachelor's Degree in Business Administration or Related FieldEducation PreferredMaster's Degree in Related FieldExperience

Required:

At least 9 years of experience in claims operations and Provider Dispute Resolution(PDRs) in a healthcare environment

At least 8 years of experience leading, supervising or managing a staff.

Proven experience in claims operations management, with a focus on process improvement and strategic planning.

Preferred:

Managed care experience.

Skills

Required:

Deep understanding of claims management, inventory management.

Ability to collaborate effectively across teams.

Strong knowledge of insurance policies, regulations, and industry standards.

Excellent leadership skills and record of accomplishment of both developing high-performing teams and successfully integrating cross-functional teams.

Strong knowledge of healthcare claims processing systems, coding standards (e.g., CPT, ICD-10), and billing regulations

Excellent analytical skills with the ability to interpret complex data and make informed decisions.

Exceptional knowledge of finance with the ability to make strategic financial decisions, understand financial implications, and manage budgets.

Possess strong organizational skills with attention to detail.

Exceptional communication and interpersonal skills, with the ability to influence and collaborate effectively at all levels of the organization.

Highly proficient with Microsoft Office Suite and related claims database applications.

Licenses/Certifications RequiredLicenses/Certifications PreferredRequired TrainingPhysical RequirementsLightAdditional Information

Salary Range Disclaimer: The expected pay range is based on many factors such as geography, experience, education, and the market. The range is subject to change.

This position is a limited duration position. The term of this position is a minimum one year and maximum of two years from the start date unless terminated earlier by either party. Limited duration positions are full-time positions and are eligible to receive full benefits.

L.A. Care offers a wide range of benefits including

Paid Time Off (PTO)Tuition ReimbursementRetirement PlansMedical, Dental and VisionWellness ProgramVolunteer Time Off (VTO)

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