Director Health Plan Administrative Operations Job Listing at MedStar Medical Group in Baltimore, MD (Job ID req24033)

Description

General Summary of Position
Reporting directly to the Vice President/COO of MedStar Family Choice Health Plan Operations, the Director will develop and implement a strategy to expand and increase E2E health plan administrative operations performance and oversight in collaboration with MedStar Family Choice and Strategic Partner leadership. This role will support enrollment and market expansion aspirations through the delivery of efficient and effective service delivery, enabling technology, collaborative relationships and demonstrated results to meet the healthcare needs of the MedStar Family Choice membership and communities it serves. Supervises and directs the activities of various levels of assigned personnel using both professional and supervisory discretion and independent judgment for claims, service, benefit configuration, new member enrollment, encounter data integrity, provider data integrity and vendor performance oversight (in partnership with Director of Vendor Contracting team). The objective of this role is to provide end-to-end health plan operations subject matter expertise to ensure optimal performance and efficiencies, reduce operating costs, foster accountability and excellence, create a culture of collaboration, and increase new member enrollment and retention.

Primary Duties and Responsibilities

Minimum Qualifications
Education

• Bachelor's degree Health Care Administration, Public Health or related field required
• Master's degree Health Care Administration, Public Health or related field preferred

Experience

• 5-7 years Experience in a health care setting with preference given to Medicaid and Medicare Plans required
• 5-7 years Leadership experience in a Senior Manager or Director role preferred

Knowledge, Skills, and Abilities

• Deep experience with specialized provider types, such as behavioral health is preferred as identified by the health plan (MFC DC or MFC MD).
• Strong working knowledge of health care and provide billing regulations related to payer reimbursement policies, specifically with CMS sponsored plans.
• Must possess excellent organizational skills, including the ability to prioritize multiple tasks and perform them accurately and simultaneously.
• Ability to work with minimal supervision, guidance and direction.
• Must be proficient with MS Office (Word, Excel, PowerPoint and Outlook).
• Proficient knowledge of Medicaid, Medicare and other third party payer requirements pertaining to E2E functions including claims, service, enrollment, documentation, coding, billing and reimbursement.
• Excellent verbal and written communication skills.
• Maintain confidentiality and comply with Health Insurance Portability and Accountability Act (HIPAA).
• Ability to establish and maintain positive and effective work relationships with members, providers, vendors and co-workers
• Demonstrated knowledge of and skill in data collection, analysis and/or interpretation of provider claims data, enrollment data and coding and configuration methodologies.

Why MedStar Health?
At MedStar Health, we understand that our ability to treat others well begins with how we treat each other. We work hard to foster an inclusive and positive environment where our associates feel valued, connected, and empowered. We live up to this promise through:

• Strong emphasis on teamwork - our associates feel connected to each other and our mission as an organization. In return, our effective team environment generates positive patient outcomes and high associate satisfaction ratings that exceed the national benchmark.
• Strategic focus on equity, inclusion, & diversity - we are committed to equity for all people and communities. We continue to build a diverse and inclusive workplace where people feel a sense of belonging and the ability to contribute to equitable care delivery and improved community health outcomes at all levels of the organization.
• Comprehensive total rewards package - including competitive pay, generous paid time off, great health and wellness benefits, retirement savings, education assistance, and so much more.
• More career opportunities closer to home - as the largest healthcare provider in the Baltimore-Washington, D.C. region, there are countless opportunities to grow your career and fulfill your aspirations.

About MedStar Health
MedStar Health is dedicated to providing the highest quality care for people in Maryland and the Washington, D.C., region, while advancing the practice of medicine through education, innovation, and research. Our team of 32,000 includes physicians, nurses, residents, fellows, and many other clinical and non-clinical associates working in a variety of settings across our health system, including 10 hospitals and more than 300 community-based locations, the largest home health provider in the region, and highly respected institutes dedicated to research and innovation. As the medical education and clinical partner of Georgetown University for more than 20 years, MedStar Health is dedicated not only to teaching the next generation of doctors, but also to the continuing education, professional development, and personal fulfillment of our whole team. Together, we use the best of our minds and the best of our hearts to serve our patients, those who care for them, and our communities. It's how we treat people.

MedStar Health is an Equal Opportunity (EO) Employer and assures equal opportunity for all applicants and employees. We hire people to work in different locations, and we comply with the federal, state and local laws governing each of those locations. MedStar Health makes all decisions regarding employment, including for example, hiring, transfer, promotion, compensation, benefit eligibility, discipline, and discharge without regard to any protected status, including race, color, creed, religion, national origin, citizenship status, sex, age, disability, veteran status, marital status, sexual orientation, gender identity or expression, political affiliations, or any other characteristic protected by federal, state or local EO laws. If you receive an offer of employment, it is MedStar Health's policy to hire its employees on an at-will basis, which means you or MedStar Health may terminate this relationship at any time, for any reason.