Director of Operations, Gov’t Programs
This role is responsible for leading operations teams within Government Programs that have responsibilities for GP products, providers, members, facilities, physician groups, members and regulatory agencies. The incumbent is accountable to ensure the employees achieve service, timeliness and quality standards as defined by internal/external clients, regulators and the marketplace and continuously review and analyze process and workflows to ensure efficiency to meet and exceed business strategies and initiatives of Horizon.
1. Oversee Government Programs operations to ensure consistent achievement of goals and targets.
2. Utilize knowledge, experience, data and tools to plan and forecast, anticipate and prepare for shifts and changes in receipts.
3. Continuously review and analyze processes and workflows. Identify opportunities to realize efficiencies and improvements.
4. Ensure appropriate interface and communications are in place with key cross-functional departments, broader enterprise departments and regulatory agencies.
5. Ensure attainment of quality and productivity standards, monitor to ensure bench mark against competitors and industry standards, and periodically review processes and workflows to ensure compatibility.
6. Capitalize on existing technology. Optimize systems capabilities. Identify and present opportunities to incorporate new technology into processes and flows. Identify opportunities to replace manual processes and interventions with technology.
7. Accountable for maintaining effective internal controls over the processes and transactions under areas of responsibility including the completeness and accuracy of financial information and transactions, compliance with applicable laws and regulations, and the effectiveness and efficiency of operations.
• BS or BA degree in a Business/Liberal Arts field from an accredited college or university. Masters degree preferred.
• Minimum 7 years experience in managerial capacity, with 5+ year in a health plan operations role.
• Experience in high volume transaction environment and experience with a variety of claims adjudication systems including FACETS.
• Knowledge of Medicaid and Medicare.
• MLTSS/DSNP experience a plus.
• Familiarity with systems implementation, insurance terminology and health plan operations
Skills and Abilities:
• Exceptional verbal and written communication skills with an ability to effectively convey information of a highly technical nature to non-technical audiences
• Strong interpersonal, collaboration and influencing skills with the ability to work with the most senior executives of the company
• Excels at multi-tasking with excellent problem solving, organizational and follow-up skills
• Ability to maintain confidentiality and trust with very sensitive information
• Ability to build consensus with senior leaders and key stakeholders