Coventry's Medicaid Division is seeking an experienced, Director level candidate to lead a centralized unit which manages the enounter process between Coventry's various state Medicaid agencies and our Medicaid health plans (both stand-alone and integrated).
ESSENTIAL RESPONSIBILITIES
- Ensures timely submission of accurate and complete enounter files including data from subcontractors (e.g. pharmacy, behavioral health, vision, dental)
- Develops monthly management reporting package regarding encounter process including acceptance rates and inventory and aging of rejections and failed edits
- Implementation and ongoing management of vendor solution for encounter processing divsion wide
- Develops and implements policies and procedures to address key business issues to ensure organizational goals and objectives are met.
- Coordinates efforts with the appropriate internal departments to develop new tools and processes.
- May assist with the identification, evaluation, and recommendation of additional programs and/or products to enhance Coventry’s cost effectiveness and quality.
- Maintains a positive work environment and structure that supports self-directed teams and optimizes the experience, skill, knowledge, and capability of the teams.
- Recruits, develops, and motivates staff. Initiates and communicates a variety of personnel actions including employment, termination, performance reviews, salary reviews, and disciplinary actions.
- Performs other duties as required.
Qualifications:
JOB SPECIFICATIONS
- Bachelor’s Degree or equivalent experience.
- Significant (7-10 years) experience in a work environment requiring substantial interaction with multiple levels of an organization (operations, middle management, and senior management).
- Previous (3 years) management experience required.
- Previous healthcare industry experience preferred.
- Understanding of the impact of encounters and claim processing on financial statements, risk score, capitation revenue and ability to understand reconciliation of claim counts and dollars paid versus encounters
- Understanding of claims processing and how that impacts encounter files
- Demonstrated ability to conduct and interpret quantitative/qualitative analysis.
- Strong analytical, organizational, communication, and presentation skills.
- Ability to use standard corporate software packages.
Coventry Health Care is an Affirmative Action/Equal Opportunity Employer, and we are committed to building a talented and diverse team.
Job: Executive/Senior Level Officials and Managers
Primary Location: , , US
Other Locations: Charleston-West Virginia-United States,Charlottesville-Virginia-United States,Richmond-Virginia-United States,King of Prussia-Pennsylvania-United States,Harrisburg-Pennsylvania-United States,Pittsburgh-Pennsylvania-United States,Omaha-Nebraska-United States,St. Louis-Missouri-United States,Brewery Park One-1333 Gratiot-48207-Detroit-Michigan-United States,6310 Hillside Ct-Suite 100-21046-Columbia-Maryland-United States,6705 Rockledge Drive-Suite 900-20817-Bethesda-Maryland-United States,Louisville-Kentucky-United States,Sunrise-Florida-United States,Tampa-Florida-United States
Organization: 10900 - CMS - STAR Corporate
Schedule: Full-time
Job Posting: 2013-01-04 00:00:00.0
Job ID: 1310026