Director, Claims Operations - Remote

As the Director Claim Operations you will play a key role in Guidehealths expansion and growth.  You will provide operational oversight of the Delegated Claims Operational departments which include Claims Production Inquiries Appeal and Disputes System Configuration Eligibility and Offshore Project management.  

WHAT YOULL BE DOING

• Direct supervision of the individual department managers including hiring training and evaluating their performance.
• Maintains and improves all claim operational functions by monitoring system performance; identifying and resolving problems; preparing and completing action plans.
• Compile review and analyze data metrics KPIs to inform leadership to assist with business decisions and improvement of processes.  
• Oversee the managers responsibilities with writing and maintaining desktop procedures within each department to ensure they are up to date and accurate.
• Identify areas within the operations workflow and system tools where improvements or enhancements can be completed to drive positive outcomes. Monitor those changes to ensure increased efficiency and production.
• Leveraging technological advantages and incorporating new workflows to scale the business.
• Conduct weekly and monthly staff meetings at direct reporting and indirect levels.
• Write new policy and procedures and submit the to the committee for approval.
• Participate in the Monthly Policy and Procedure committee meetings responsible for the review and approval of new or updated policies from all departments.
• Vendor management negotiations and AR approval.
• Financial budget review of each department.
• Ensure compliance with state and federal regulations and company policies.
• Provide expert advice and guidance to other employees and senior management on other teams.
• Oversight of the configuration of the system from the standpoint of eligibility system benefit configuration fee schedules and provider maintenance.
• Attend operational leadership meetings.
• Present KPI Benchmarks and Metrics at leadership meetings.

Qualifications :

WHAT YOULL NEED TO HAVE 

• Minimum 3 - 5 years experience in Management of claim operations and proven leadership skills.
• Certified Professional Biller (CPB) Certified Professional Coder (CPC) or other similar certifications.
• Advanced knowledge of claim processing including claims data analysis and the setting tracking and reporting on performance metrics.
• Proficient with Microsoft applications Excel Word Access and Power Point.
• Experience with EDI transactions.
• Strong understanding of healthcare regulations insurance contracts and reimbursement processes.
• Ability to work independently with minimal supervision. Exceptional judgement in escalating concerns to next level leadership.
• Exceptional written visual and verbal communication is necessary to lead a team and convey clear instruction.
• Comfortable with public speaking.

WHAT WED LOVE FOR YOU TO HAVE

• Bachelors degree in healthcare administration business or related field
• Prior claims processing experience within Eldorado HealthPac Claims Adjudication System is a plus.

Additional Information :

The salary for this role is up to $105k per year based upon experience and skills.

ALIVE with Purpose: How We Thrive at Guidehealth 

At Guidehealth our values come to life in everything we do. 

• We are Driven by Accountability grounded in transparency reliability and integrity as we navigate challenges and opportunities alike. 
• Always Growing Always Learning staying curious and continuously improving inspires us to shape a better future for healthcare. 
• With Collaborative Innovation we solve problems creatively making every experience better for our employees and the patients we serve. 
• At Guidehealth Every Voice Matters we believe our collective strength is rooted in the unique perspectives of each team member. 
• And through Empathy in Action we build stronger connections with those who count on us. 
• This is what it means to be ALIVE with purpose. This is how we thrive together at Guidehealth. 

BENEFITS:

All full-time employees of Guidehealth who work 30 hours per week or more are eligible for our comprehensive benefits package. While you are hard at work advancing value-based healthcare we are here to ensure YOU have the care you and your family need and the opportunities for growth and development. Our commitments to you include:

• Work from Home: Guidehealth is a fully remote company providing you the flexibility to spend less time commuting and more time focusing on your professional goals and personal needs.
• Keep Health a Priority: We offer comprehensive Medical Dental and Vision plans to keep you covered.
• Plan for the Future: Our 401(k) plan includes a 3% employer match to your 6% contribution.
• Have Peace of Mind: We provide Life and Disability insurance for those just in case moments. Additionally we offer voluntary Life options to keep you and your loved ones protected.
• Feel Supported When You Need It Most: Our Employee Assistance Program (EAP) is here to help you through tough times.
• Take Time for Yourself: We offer paid time off plans helping you achieve work-life balance and meet your personal goals.
• Support Your New Family: Welcoming a new family member takes time and commitment. Guidehealth offers paid parental leave to give you the time you need.
• Learn and Grow: Your professional growth is important to us. Guidehealth offers various resources dedicated to your learning and development to advance your career with us.

COMPENSATION:

The listed compensation range listed is paid bi-weekly per our standard payroll practices. Final base pay decisions are dependent upon a variety of factors which may include but are not limited to: skill set years of relevant experience education location and licensure/certifications.

OUR COMMITMENT TO EQUAL OPPORTUNITY EMPLOYMENT 

Diversity inclusion and belonging are at the core of Guidehealths values. We are an equal opportunity employer. We enthusiastically accept our responsibility to make employment decisions without regard to race religious creed color age sex sexual orientation and identity national origin citizenship religion marital status familial status physical sensory or medical disability Family and Medical Leave military or veteran status pregnancy childbirth or other related medical conditions or any other classification protected by federal state and local laws and ordinances. Our management is fully dedicated to ensuring the fulfillment of this policy with respect to hiring placement promotion transfer demotion layoff termination recruitment advertising pay and other forms of compensation training and general treatment during employment. 

OUR COMITTMENT TO PROTECTION OF PATIENT AND COMPANY DATA

This position is responsible for following all Security policies and procedures in order to protect all PHI and PII under Guidehealths custodianship as well as Guidehealth Intellectual Properties.  For any security-specific roles the responsibilities would be further defined by the hiring manager. 

REMOTE WORK TECHNICAL REQUIREMENTS

Guidehealth is a fully remote company. We provide new employees with the necessary equipment to function in their role at no charge to the employee. Employees provide their own internet connection capable of conducting video calls on camera and connecting to various internal and external systems. The required internet speed is a minimum of 50 mbps download 10 mbps upload. Please consult with your internet provider or run a speed test here to confirm your internet connection meets these requirements.

Remote Work :

Yes

Employment Type :

Full-time