Director, Out of State Medicaid

THE JOB RESPONSIBILITIES INCLUDE

• Ensure the processes and inventory are in place to hit monthly, quarterly, and annual revenue expectations for the company.
• Lead multiple teams through Managers and Supervisors by establishing daily, monthly, and strategic goals, ensuring alignment to revenue targets and operational priorities.
• Oversee hiring, onboarding, and performance management across assigned teams, ensuring strong leadership capability and team effectiveness.
• Oversee performance management processes, including goal setting, performance reviews, and accountability frameworks across Managers and Supervisors.
• Oversee workload distribution and capacity planning across teams to ensure efficient execution and alignment with business priorities.
• Perform regular audits and client reviews ensuring EC is delivering all requirements to the satisfaction of the client.
• Measures and monitors key performance metrics and delivers concise performance reporting to stakeholders with corrective action plans for variances when appropriate.
• Assists in setting the strategic direction of the Out-of-State Medicaid team and identifies areas of continuous improvement in conjunction with the leadership team.
• Maintain a strong knowledge of insurance billing and reimbursement procedures and regulations.
• Researches and analyzes collections systems processes in Enforcer, including process improvement and SOP enhancement recommendations.
• Coordinate cross-functional resources to execute action plans for assigned accounts and resolve operational challenges impacting performance.
• Oversee the implementation and adherence to quality and productivity standards across teams, ensuring consistency and accountability.
• Set and adjust priorities across teams to ensure optimal resource allocation and focus on the most impactful and profitable work.
• Ensure compliance with HIPAA and related regulatory requirements through oversight of processes, policies, and team adherence.
• Hold Managers and Supervisors accountable for team performance, including productivity, quality, and adherence to workflows and service level expectations.
• Develop and strengthen leadership capability by coaching Managers and Supervisors, building a pipeline of future leaders.
• Provide guidance and oversight on complex performance management matters, ensuring consistent application of expectations and company policies.
• Support operational and business transformation initiatives, ensuring adoption and execution across teams.
• Maximize efficiency and productivity through extensive process analysis and interdepartmental collaboration.
• Assist with audits and client reviews, ensuring EC is delivering all requirements to the satisfaction of the client.
• Other duties as required

REQUIREMENTS AND QUALIFICATIONS

• Bachelor’s degree in business or healthcare administration preferred. High School Diploma or GED required.
• 7-10 years’ experience in management or supervisory experience with team size of 10+.
• 6+ years’ experience in healthcare setting, information technology company or managed care industry, preferably in the area of Finance/Collections, Business Operations or Revenue Recovery.
• Experience working with internal teams while serving in a client facing or client support role.
• Knowledge and understanding of financials, HMO’s, hospital revenue cycle process, ancillary and provider contract language and familiarity with healthcare and provider data sets.
• Extensive level of understanding of insurance payer/provider claim processing and subsequent data requirements.
• Must have strong computer proficiency and understand how to use basic office applications, including MS Office (Word, Excel, and Outlook).
• Timely and regular attendance.
• Equivalent combination of education and experience will be considered
• To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. Reasonable accommodations may be made to enable qualified individuals with disabilities to perform the essential functions.

SPECIAL CONSIDERATIONS & PREREQUISITES

• Practices and adheres to EnableComp’s Core Values, Vision and Mission
• Strong and professional written and oral communications skills.
• Has worked in a production environment and can meet deadlines.
• Excellent people skills to interface with multiple internal stakeholders.
• Demonstrated ability to successfully work collaboratively within a team and cross-functionally.
• Proven success in obtaining quantifiable results from and setting priorities for direct reports.
• Organized and can handle multiple projects simultaneously.
• Ability to set and manage multiple priorities among several teams.
• Experience communicating obstacles & challenges and developing action plans to present to management.

Originally posted on Himalayas