Note: The job is a remote job and is open to candidates in USA. The Aspen Group (TAG) is one of the largest and most trusted retail healthcare business support organizations in the U.S. and has supported over 20,000 healthcare professionals and team members. They are seeking a Director of National Operations to oversee national plan relationships and contract strategy across their Aspen Dental and WellNow brands.
Responsibilities
- Develops and maintains effective working relationships with insurance company contacts for assigned national plans
- Oversee the entire operational relationship with assigned national plans across Aspen Dental and WellNow, including grievances, rate validation, educational outreach, and any other operational issue that affects the plan
- Proactively looks for ways to improve support to Aspen offices, streamline processes with plans, and increase transparency and issue resolution for offices and owners
- Oversee and participate in Joint Operating Committees (JOCs) for assigned national plans, driving continued results with plan partners
- Ensures audits occur monthly for national plans to confirm accurate network information and drive quick resolution of contract data issues
- Identifies trends across markets and partners with department heads to build educational resources for the plans
- Oversee the distribution of field education and company initiatives to the field as needed
- Acts as an expert resource on escalated contractual and compliance issues for national plans
- Monitors contract performance and other provisions to assure compliance, identify problem areas, and resolve disputes
- Resolves escalated contract issues generated by operational department heads
- Works collaboratively with payors and Aspen Department Leadership (Legal/Compliance, Finance, Centralized Billing, and IT) on strategic business development efforts to ensure geographic reach, plan and service types, and optimal reimbursement rates
- Other duties as assigned
- Train, support, and develop the team to meet department metrics and expectations
- Ensure the team delivers first class customer service to owners
- Efficiently resolves plan related issues raised by owners and the field
- Creates education and resources for the field so they have what they need
- Coaches the team on grievance handling and root cause identification to prevent repeat issues
Skills
- Bachelor's degree
- Highly proactive, with strong critical thinking skills and the ability to architect solutions rather than just flag problems
- Direct experience with insurance and provider contracting required. Must have been personally involved in managed care contracting or contract strategy work, not just adjacent to it
- Strong exposure to healthcare operations required. Dental experience is not required; medical or other clinical operations experience is a fit
- Broad knowledge of healthcare insurance, healthcare billing and reimbursement, administration, systems, practices and principles (i.e. Medicare, Medicare Advantage, and Commercial)
- Knowledge and ability to effectively use negotiation techniques and practices to advocate for providers
- Excellent verbal and written communication
- Excellent time management, prioritization, and organizational skills
- Detail oriented with a strong level of analytical and problem-solving skills
- Proficient use of Microsoft Office Suit
- 7 or more years of progressively responsible management or supervisory level managed care contracting experience in a payor or health care setting, with experience across multiple brands or business lines preferred
Benefits
- A generous benefits package that includes paid time off, health, dental, vision, and 401(k) savings plan with match
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