Note: The job is a remote job and is open to candidates in USA. WellSense Health Plan is a nonprofit health insurance company serving members across Massachusetts and New Hampshire. The Senior Director will lead the delivery, support, compliance, and continuous improvement of Encounters submissions to MassHealth and New Hampshire DHHS, while managing the Encounters Operations team, vendors, budgets, quality metrics, issue resolution, and audit responses.
Responsibilities
- Strategic Leadership : In collaboration with Senior Leadership, establish and drive WellSense’s technology and operational strategy for delivery of Encounters submissions to MassHealth and New Hampshire DHHS. This includes establishing quality protocols, documentation, and processes for ongoing submission
- Management : Lead and manage the IT Encounters Operations Team of data and operations analysts charged with the timely and accurate submission of Encounters
- Budget and Cost Estimation : Work with the Vice President of Cloud Data Platform to determine estimated costs of IT Encounters Operations and vendor costs associated with operations. Track actual spend against budget and document reasons for variance
- Data Privacy and Security : Ensure that Encounters data is compliant with applicable HIPAA and other WellSense policies for data privacy and security
- Compliance : Ensure that Encounters submissions comply with federal and state service levels for timeliness and quality. Collaborate with WellSense Compliance and other departments to respond to audits and other requests on-time
- Continuous Improvement : Ensure the establishment and management the end-to-end processes for Encounters data management from source to final Encounter resolution
- Vendor Relationships : Partner with strategic vendors in the implementation of Encounters processes. Manage budgets, contractual agreements, and support for critical initiatives
- Problem Solving : Create and manage the Encounters issue resolution process that includes the documentation of the receipt/acknowledgement of issues, root-cause analysis, and the creation of plans to resolve issues within the timeframes established by the states
- Quality : Establish and monitor quality metrics for Encounters Management and review with Senior Management on a regular basis
- Collaboration : Work across internal and external groups to communicate Encounters priorities and work with management across teams to ensure adequate staffing is available to address issues and implement new initiatives, respond to audit requests, and support internal/external reporting needs
- Regulatory Knowledge : Monitor state and state related agency guidelines on submission requirements and rules for Encounter submissions. Ensure stakeholders are aware of any changes and create plans to meet changing requirements within the timeframes specified by the states
Skills
- • Demonstrated success in leading Encounters Operational teams for similarly sized organizations
- • Effective communicator who can synthesize complex issues into simple language to accurately communicate to colleagues, Senior Management and representatives from Mass Health and New Hampshire DHHS
- • Experience in managing Corrective Action Plans issued by regulatory bodies. This includes documenting root cause analyses and creating executing on the plans
- • Working knowledge of HIPAA and PHI data handling standards
- • Thorough understanding of the claims lifecycle and the Encounters submission lifecycle
- • Strong project/program management skills and ability to hold accountable individuals who may not be in the person's line of supervision
- • Strong understanding of data warehousing technology and design
- • Willingness to get hands-on in the execution of the team's work including the ability to use tools such as Jira and Confluence to organize initiatives into stories and sprints and to lead daily stand-up meetings to ensure on-time delivery of projects. Use Confluence to document Encounters processes, tools, etc
- • Detail oriented, excellent proof reading and editing skills
- • Bachelor's or master's degree, or equivalent experience, in computer science, Engineering, or a related field
- • 10+ years of managing data and operational analysts
- • 7+ years of leading encounters operations functions for a healthcare plan
- • Occasional travel may be required
Benefits
- Full-time remote work
- Medical, dental, vision, and pharmacy benefits
- Merit increases
- Flexible Spending Accounts
- 403(b) savings matches
- Paid time off
- Career advancement opportunities
- Resources to support employee and family wellbeing
Company Overview
Company H1B Sponsorship