Morgan Consulting Resources, Inc. - Healthcare Executive Search
Senior Director, Claims
Morgan Consulting Resources, Inc. - Healthcare Executive Search, Rancho Cucamonga, California, United States, 91739
Overview
Senior Director, Claims role at Morgan Consulting Resources, Inc. - Healthcare Executive Search. The position is with Inland Empire Health Plan (IEHP) in Rancho Cucamonga, CA. A hybrid schedule is available (three days in the office and two days remote). About the Organization
Inland Empire Health Plan (IEHP) is one of the top 10 largest Medicaid health plans and the largest not-for-profit Medicare-Medicaid plan in the country. IEHP supports nearly 1.6 million members enrolled in Medicaid, with a growing network of over 8,000 providers and nearly 4,000 team members. IEHP is committed to its Mission, Vision, and Values. IEHP has been recognized as a Great Place to Work. About the Position
Reporting to the Chief Financial Officer, the Senior Director, Claims will manage the Director, Claims and be responsible for the strategy, design, and implementation of claims payment processes. The Senior Director will provide regulatory directive and operational guidance to ensure the organization’s compliance requirements are met. Responsibilities
Oversee claims production and vendor oversight for all lines of business Ensure adequate quality controls and participate with support departments to analyze the root cause of claim payment variations Ensure claim support services achieve high provider satisfaction and timely dispute/appeal responsiveness Establish, implement, and provide improvements to internal controls and department policies and procedures Interact with Core Configuration team and vendors to ensure claims systems are robust, compliant and supports business developmental needs Influence and drive change among executive leadership and others within the organization Draft and oversee implementation of future state processes and systems needed to support strategic direction Provide coaching and guidance to the Director of Claims to ensure staffing and operational support needs are met Experience Requirements
Ten (10) years healthcare administration experience Four (4) years minimum in a Director level role or above Two (2) years of experience with an HMO or managed care experience Medi-Cal/Medicaid claims experience required and Medicare/DSNP/ACA Exchange experience preferred Educational Requirements
Bachelor\'s degree in business administration, accounting, or healthcare from an accredited institution required Master’s degree from an accredited institution preferred Knowledge & Skills
Solid understanding of rules and regulations governing Medi-Cal benefits and claims adjudication practices and procedures Principles and techniques of supervision and training Data entry involving computer keyboard and screens, filing, and copying of records and/or correspondence Compensation
Base pay range: $220,043.20/yr - $385,049.60/yr Presented by: Erica Eikelboom, Principal & Executive Search Consultant
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Senior Director, Claims role at Morgan Consulting Resources, Inc. - Healthcare Executive Search. The position is with Inland Empire Health Plan (IEHP) in Rancho Cucamonga, CA. A hybrid schedule is available (three days in the office and two days remote). About the Organization
Inland Empire Health Plan (IEHP) is one of the top 10 largest Medicaid health plans and the largest not-for-profit Medicare-Medicaid plan in the country. IEHP supports nearly 1.6 million members enrolled in Medicaid, with a growing network of over 8,000 providers and nearly 4,000 team members. IEHP is committed to its Mission, Vision, and Values. IEHP has been recognized as a Great Place to Work. About the Position
Reporting to the Chief Financial Officer, the Senior Director, Claims will manage the Director, Claims and be responsible for the strategy, design, and implementation of claims payment processes. The Senior Director will provide regulatory directive and operational guidance to ensure the organization’s compliance requirements are met. Responsibilities
Oversee claims production and vendor oversight for all lines of business Ensure adequate quality controls and participate with support departments to analyze the root cause of claim payment variations Ensure claim support services achieve high provider satisfaction and timely dispute/appeal responsiveness Establish, implement, and provide improvements to internal controls and department policies and procedures Interact with Core Configuration team and vendors to ensure claims systems are robust, compliant and supports business developmental needs Influence and drive change among executive leadership and others within the organization Draft and oversee implementation of future state processes and systems needed to support strategic direction Provide coaching and guidance to the Director of Claims to ensure staffing and operational support needs are met Experience Requirements
Ten (10) years healthcare administration experience Four (4) years minimum in a Director level role or above Two (2) years of experience with an HMO or managed care experience Medi-Cal/Medicaid claims experience required and Medicare/DSNP/ACA Exchange experience preferred Educational Requirements
Bachelor\'s degree in business administration, accounting, or healthcare from an accredited institution required Master’s degree from an accredited institution preferred Knowledge & Skills
Solid understanding of rules and regulations governing Medi-Cal benefits and claims adjudication practices and procedures Principles and techniques of supervision and training Data entry involving computer keyboard and screens, filing, and copying of records and/or correspondence Compensation
Base pay range: $220,043.20/yr - $385,049.60/yr Presented by: Erica Eikelboom, Principal & Executive Search Consultant
#J-18808-Ljbffr