Note: The job is a remote job and is open to candidates in USA. WellNow Urgent Care is part of The Aspen Group, a leading retail healthcare business support organization in the U.S. They are seeking a Director of Regional Operations and Process Assurance to oversee regional operations for Aspen Dental, manage local plan relationships, and ensure process assurance through proactive audits and standard operating procedures.
Responsibilities
- Develops and maintains effective working relationships with insurance company contacts for assigned regional plans
- Oversee the entire operational relationship with assigned regional plans, 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 regional plans, driving continued results with plan partners
- Owns and maintains data sources to ensure network and contract processes remain accurate
- Manages and updates standard operating procedures
- Proactively audits data monthly to confirm accurate network information and quickly resolve 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 within the region
- Monitors contract performance and other provisions to assure compliance, identify problem areas, and resolve disputes
- Resolves escalated contract issues generated by operational department heads
- 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
- 7 or more years of progressively responsible management or supervisory level managed care contracting or provider network operations experience in a payor or health care setting, including experience leading audit, quality assurance, or process improvement functions
- Broad knowledge of healthcare insurance, healthcare billing and reimbursement, administration, systems, practices and principles (i.e. Medicare, Medicare Advantage, and Commercial)
- Experience building and enforcing standard operating procedures and audit processes
- 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 Suite
Benefits
- A generous benefits package that includes paid time off, health, dental, vision, and 401(k) savings plan with match
Company Overview