To provide overall leadership & direction for an organization, directly responsible for premium billing of billions of dollars, reconciling membership of nearly half a million members, & ensuring ID cards are sent timely & accurately. The position also has ultimate accountability for all direct & indirect Membership Administration work processes & systems that support all the region's new products, accurately record membership data & dues, ensure the timely collection of premium, & provide customer service to groups & internal customers. This position represents KP of the Mid-Atlantic Membership on all Regional & National projects & committees.
Essential Functions:
- Manages the effective conduct of the Membership Accounting Department.
- Establishes & manages the Membership Accounting Operating Budget.
- Accountable for all SOX, Medicare, NCQA & associated local & national compliance rules & regulations.
- Assures that Management Controls exist to support the efficient & effective administration of the billing, collection, & reporting of premium dues in the billions.
- Ensures timely & accurate entries to financial statements for revenue & receivables.
- Oversees the administration of insurance eligibility records for over approximately half a million members.
- Develops & implements regional operating policies, standards, & procedures for Membership Administration consistent with regional & national guidelines.
- Develops & achieves goals & objectives that are consistent with regional goals.
- Analyzes departmental activities to evaluate their effectiveness.
- Leads the development & implementation of new processes, systems, activities, & programs.
- Ensures that the Department follows best business practices of KP & the Health Care Industry.
- Partners with Health Plan Administration Directors to support the Local & National Health Plan Administration Agenda.
- Represents KP-MAS on all the National Membership Community of Practice, as well as any other national initiative requiring Membership involvement & participation.
- Accountable for overseeing the Group & Member installation process & making improvements to the accuracy & efficiency of these processes, & ensuring all appropriate controls are in place & compliant with local & national regulations.
- Confers with departmental managers, directors, & supervisors within & outside the organization to ensure customer satisfaction regarding Membership Administration Services, & related data processing systems, policies, & procedures.
- Specifically provides & direction in working with Marketing & Sales & provides leadership in resolving any member or billing related issues on behalf of Marketing & Sales.
- Develops & interprets company policies & Health Plan contracts, & implements government regulations as they relate to Membership Administration functions. Interact with external & internal departments to assure that proper Membership Administration consideration is given to new products, services, or initiatives.
- Serves as the Business Owner for the Regional Membership System.
- Realization Team Lead for all system enhancement projects for the Membership System.
- Prioritize KPIT Membership System service requests.
- Is responsible for ensuring that the department's operations & business practices are conducted in a manner that is compliant with regulatory requirements for all applicable jurisdictions.
- Coordinates internal & external audits.
- Reports Directly to the Vice President of Health Plan Administration.
- Assure that department performance & priorities are in alignment with Regional expectations.
- This job description is not all encompassing.
Qualifications:
Basic Qualifications:
- Twelve (12) years of experience in positions of increasing responsibility in Health Care Insurance or financial operations required.
- Eight (8) years of management or director level experience at a large, complex organization, including experience leading teams and managing strategic initiatives required.
- Experience with development and implementation of new products, systems and processes required.
- Experience in a complex organization that requires cross-functional collaboration and communication to achieve organization objectives required.
- Experience with interacting with Senior Leadership of a large organization required.
- Experience implementing change required.
- BA/BS degree in Business or related field required.
- Ability to lead discussions on difficult or sensitive issues to influence executive leaders towards achieving desired outcomes and common goals required.
- Ability to build teams and lead professionals and manage through influence and cooperation is required.
- Comfort with directing, reviewing and presenting complex analysis, findings and recommendations required.
- Demonstrated strategic and creative approach to identifying and implementing solutions to complex issues required.
- Working knowledge of automated systems required.
- Excellent communication, presentation, problem solving, interpersonal and collaboration skills required.
- Knowledge of Management Techniques, Accounting Principles, and applicable Regulations for VA, MD, and DC required.
- Orientation toward SMART goal setting and performance management to achieve bottom line results are required.
Preferred Qualifications:
- Master's degree, MBA, or CPA preferred.
- Current experience as a leader overseeing Membership Administration, Transactions/Inventories/Systems/Operations, and/or high volume claims strongly preferred.
External hires must pass a background check/drug screen.
We are proud to be an equal opportunity/affirmative action employer.