Dir- Medicare Operations
Awarded the Best Place to Work 2021, Blue Cross Blue Shield of Arizona helps to fulfill its mission of improving the quality of life of Arizonans by delivering a variety of health insurance products and services to meet the diverse needs of individuals, families, and small and large businesses as well as providing information and tools to help individuals make better health decisions.
PURPOSE OF THE JOB
Acts as a talent and culture ambassador for the Medicare Operations team in support of hiring, training, and retaining the best talent and in connecting employees emotionally to our Vision and Mission. Employee Engagement is a critical accountability in this role as our customers will never be happier or more satisfied than our employees are engaged.
Coordinates end-to-end tactical execution across the Medicare Advantage (MA) ecosystem to maximize customer engagement, operational performance and operations financial stewardship, to ensure we remain in compliance with all applicable regulations, and to support the growth strategy of the Government Segment. Direct leadership accountability and authority for Medicare Operations teams up to and including Contact Center, Claims, Enrollment, Complaints, Appeals, & Grievances for internal and external entities, Delegation Oversight, and Operational Quality.
Collaborates and coordinates across the enterprise and with external delegates and entities to ensure all aspects of our operational processes follow CMS guidelines and have appropriate change controls to ensure we remain compliant.
Required Work Experience
3 years leading people and operations to success
5 years of experience in healthcare field; strong preference for demonstrated Medicare and Medicaid operations experience
High School diploma or GED in general field of study
Preferred Work Experience
5 years leading people and healthcare operations to success
7 years of experience in healthcare field; strong preference for demonstrated Medicare and Medicaid operations experience
3 years of experience developing short and long range strategic plans, forecasting, and budgeting
BA or BS degree in business administration, healthcare, or related field
ESSENTIAL JOB FUNCTIONS AND RESPONSIBILITIES
Strategically plan with internal constituents the direction for MA Operations to ensure compliance and to maximize performance for the program.
Create a winning-team and provides a customer focused direction to assure our members retain and recommend BCBS. Strategize and plan with other teams, as appropriate, to delight our members and provide member centric business solutions.
Provide leadership and mentorship to team members in the area of strategy, research, best-practices analysis, business analysis and ultimately good business solutions in moving the program forward.
Develop and manage strategy and operations to ensure quality service and timely, accurate processing of MA claims. Ensure maximum performance standards as defined by CMS.
Develop and track all staff statistics, providing feedback in a timely manner as agreed upon with management. Coach staff to success by setting the path for expectations and continuous development.
Track and report service metrics daily, weekly, monthly and annually, by FTE, service unit and division.
Maintain compliance and ensure reporting timeliness in accordance with CMS standards.
Monitor and maintain performance levels to meet all performance standards determined by the senior leadership team.
Resolve problems, complaints, and difficult situations related to production and member impacts.
Ensure staff is properly trained to provide full service to customers, by phone, in writing, electronically, or in person.
Ensure staff understanding of and monitor compliance with security and privacy requirements, including HIPAA and CodeBlue.
QUALITY AND SYSTEMS
Coordinate and assist in development of enhancements to systems or creations of new systems to improve efficiencies to processing.
Evaluate and expedite workflow and monitor standards for evaluating and processing and for performance level of employees.
Oversee day-to-day departmental administration by coaching and motivating managerial staff and departmental personnel to make maximum use of experience and skills.
Monitor quality performance measures, develop and maintain effective workflows, and seek to maximize system efficiencies.
Represent the MA Operations area in external meetings, both at a local and national level. Participates on an internal basis in meetings and decision-making processes relative to the specific areas of responsibility.
Manage use of corporate funds including budgeting, financial management, and reporting. Identify opportunities to achieve administrative efficiencies while maintaining service.
Maintain effective working relationships to ensure teamwork in achieving corporate goals.
Participate in strategic planning activities and contribute to departmental and cross-functional teams to achieve BCBSAZ goals and ensure future success.
Coordinate activities between multiple areas to achieve desired results.
Support BCBSAZ’s Core Value of maintaining a heritage of service through community involvement.
The position requires a full-time work schedule. Full-time is defined as working at least 40 hours per week, plus any additional hours as requested or as needed to meet business requirements.
Perform all other duties as assigned.
Required Job Skills
Strong written and verbal communications.
Intermediate knowledge of electronic data processing systems, technology, and applications.
Intermediate PC proficiency.
Intermediate skill in word processing, spreadsheet and database software.
Required Professional Competencies
Leadership & Management skills in an operationally changing environment, with drive for accurate, timely, and cost-effective results on planned objectives.
Expert knowledge of quality and cost-effective service.
Expert knowledge of the principles and practices of healthcare prepayment.
Expert customer service skills.
Interpersonal skills that allow for collabrative relationships with providers, members and coworkers.
Recognize strategic opportunities and use data to make timely and sound decisions.
Flexibility and willingness to adjust to shifting demands/priorities.
Ability and experience to assimilate multiple new functions, services, projects and systems while maintaining existing systems and programs.
Required Leadership Experience and Competencies
High standard of performance while developing and pursuing aggressive goals
Principled leadership and sound business ethics; willing to consider and take calculated and measured risks to achieve growth strategy
Preferred Job Skills
Preferred Professional Competencies
Preferred Leadership Experience and Competencies
BCBSAZ does not discriminate in hiring or employment on the basis of race, ethnicity, color, religion, sex, sexual orientation, gender identity, national origin, age, disability, protected veteran status or any other protected group.
Thank you for your interest in Blue Cross Blue Shield of Arizona. For more information on our company, see azblue.com. If interested in this position, please apply.