Director Operations Account Management

JOB SUMMARY:

The Director of Operations Account Management will work to advance AMERIGROUP’s strategic imperatives as the primary link between Service Operations and the various Health Plan Operations. The incumbent will be responsible for communicating Service Operations performance dashboards, operations policies, OPEX, and best practices to the Health Plans. The incumbent will build strong working relationships with peers and senior management at the Health Plans and within Service Operations support areas to assist in meeting the goals of the organization. In addition, the incumbent will demonstrate high levels of flexibility by managing projects across multiple Health Plan’s based on strategic priorities. The incumbent will be responsible for identifying and prioritizing operational opportunities for improvement in the areas of efficiency and effectiveness.

PRIMARY RESPONSIBILITIES:

1.Partners and supports management across Service Operations on assigned projects ensuring company goals and initiatives are met
2.Participates in Operational process improvement initiatives and facilitates collaborative effort between Service Operations and Health Plan Operations for implementation
3.Demonstrate mastery of process improvement methodology (i.e. Six Sigma certification) in appropriate timeframe as directed by management
4.Works with Service Operations to ensure appropriate key operational indicators are in place for monitoring and analysis
5.Identifies and maintains inventory of issues and defects related to Service Operations. Routinely provides inventory reports to management for awareness and resolution
6.Identifies opportunities for Operational Excellence and works to create seamless processes between Service Operations and Health Plan Operations
7.Works with Service Operations departments to resolve operational issues including, but not limited to enrollment, benefit configuration, call metrics, authorizations, high dollar claims, pended claims, CAMP, provider data, appeals, adjustments, customer service, and Facets related issues
8.Assists Health Plan Provider Relations with the resolution of defects resulting from the provider contract request, configuration and implementation processes
9.Maintains awareness of strategic initiatives to ensure priority alignment and promotes Health Plan communication and collaboration
10.Recognizes and utilizes appropriate channels for communication, encourages two-way communication with Health Plan and Service Operations staff to improve efficiency and enhance job performance
REQUIREMENTS
JOB REQUIREMENTS:

Education and Experience:
•Bachelor’s Degree or equivalent experience in Business, Health Care or related field; Master’s Degree preferred
•Minimum of eight years work related experience
•Project management or leadership experience in a medium to large size business environment.
•Experience with change management

Certification and Licensure:
•Black belt quality certification a plus

Knowledge and Skills:
•Excellent analytical, organizational, problem-solving, and communication skills
•Ability to demonstrate political sensitivity and to work effectively with senior level management as well as with multi-disciplinary teams across department lines
•Demonstrated leadership in healthcare operations including claim payment and root cause identification
•Strong leadership, coaching, and staff development skills
•Conflict resolution/mediation experience
•FACETS operating system experience a plus
•Clinical or coding skills a plus
•Quality training a plus

Physical Requirements:
•Must be able to operate a computer
•Must be able to operate a phone
•Ability to travel a minimum of 25%, as required