Director, Out of State Medicaid

This is a fully remote position, open to applicants in Tennessee.

📋 Description

• Ensure that processes and inventory align with monthly, quarterly, and annual revenue targets.

• Lead various teams through Managers and Supervisors, establishing both operational and strategic objectives.

• Oversee the hiring process, onboarding, performance management, workload distribution, and capacity planning.

• Conduct audits and client reviews to ensure compliance with requirements.

• Monitor key performance indicators and provide performance reports along with corrective action plans.

• Assist in setting the strategic direction and identifying continuous improvement opportunities for the Out-of-State Medicaid team.

• Maintain up-to-date knowledge of insurance billing and reimbursement procedures and regulations.

• Analyze collections system processes in Enforcer, recommending improvements for processes and SOPs.

• Coordinate cross-functional resources to implement account action plans and troubleshoot operational challenges.

• Oversee quality, productivity, workflow, service levels, and compliance standards, including HIPAA regulations.

• Mentor Managers and Supervisors while developing future leadership capabilities.

• Support initiatives for operational and business transformation.

• Enhance efficiency through process analysis and collaboration across departments.

⛳️ Requirements

• High School Diploma or GED is required.

• A Bachelor’s degree in business or healthcare administration is preferred.

• 7–10 years of management or supervisory experience overseeing teams of 10 or more.

• At least 6 years of experience in a healthcare setting, information technology company, or managed care industry.

• Experience in Finance/Collections, Business Operations, or Revenue Recovery is preferred.

• Proven experience working with internal teams in client-facing or client-support roles.

• Knowledge of financials, HMOs, hospital revenue cycle processes, ancillary and provider contract language, and healthcare/provider data sets.

• Extensive understanding of insurance payer/provider claim processing and associated data requirements.

• Strong computer skills with proficiency in MS Office, including Word, Excel, and Outlook.

• Consistent and reliable attendance.

• An equivalent combination of education and experience will be considered.

• Strong professional communication skills, both written and oral.

• Experience in a production environment with the ability to meet deadlines.

• Excellent interpersonal skills for engaging with multiple internal stakeholders.

• Proven ability to collaborate in a team environment and work cross-functionally.

• Track record of achieving measurable results and setting priorities for direct reports.

• Highly organized, capable of managing multiple projects simultaneously.

• Ability to set and manage multiple priorities across different teams.

• Experience in communicating challenges and obstacles while developing action plans for management.

🏝️ Benefits

• Opportunities for professional growth and development.

• Access to tools, resources, and support for career advancement.

• A flexible and family-oriented work environment.

• Support for work-life balance.

• Recognized as a top employer by Workplaces.