Director, Provider Network Operations

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

📋 Description

• Lead strategic initiatives for Provider Network Operations, which encompass network establishment and maintenance, provider data accuracy, provider education and service, contract execution, provider-related claims, provider setup and audits, corrective action strategies, and the precision of the provider directory.

• Collaborate with Provider Reimbursement Insights and Analytics to achieve organizational goals.

• Direct the efforts of the Credentialing division to ensure compliance and operational excellence.

• Create strategies for provider education and relationship management.

• Spearhead the integration and operational efficiency of provider network platforms with both legacy and new systems.

• Work alongside software vendors, IT teams, and internal stakeholders to enhance interoperability and system compatibility.

• Ensure that integrated systems adhere to state, federal, NCQA standards, and organizational policies.

• Design automated workflows and processes for data synchronization across various platforms and departments.

• Enhance functionality using LEAN methodologies and resources.

• Engage in strategic planning, execution, resource allocation, and performance monitoring.

• Collaborate with executive leadership on processes, technology, human resources, performance metrics, and efficiency objectives.

• Oversee collaborative efforts with providers and coordinate with other departments and leaders.

• Guide functional leaders in formulating business plans.

• Create and present provider education programs.

• Evaluate provider feedback and implement enhancements to relationships.

• Work in conjunction with Operations, IT, Health Services, Analytics, Finance, and other departments.

• Supervise annual IT work plans, initiative work plans, financial budgets, and resource requirements.

• Develop coaching and training programs in collaboration with division leaders.

• Manage hiring, staff development, coaching, performance evaluations, and employee engagement.

• Administer division budgets and expenditures, implementing corrective actions when necessary.

• Participate in Manager/Supervisor meetings, PRISM walks, internal committees, and departmental activities.

• Evaluate innovative provider payment methodologies for approval and implementation.

• Meet departmental and company performance and attendance standards.

• Adhere to privacy and HIPAA regulations.

• Perform additional duties as assigned.

⛳️ Requirements

• A minimum of 8 years of experience in a leadership position overseeing healthcare provider network operations or similar functions.

• Preferably, experience leading at least two of Provider Relations, Credentialing, and Provider Data Management.

• Experience managing extensive, multi-tiered teams and complex operational portfolios.

• Understanding of provider reimbursement methodologies, provider network operations, compliance requirements, and healthcare data management.

• Experience in developing and executing strategies within a matrixed organization is preferred.

• A Bachelor’s degree in business, healthcare administration, finance, or a related field is required.

• An Associate’s degree combined with 2 years of relevant experience, or a high school diploma with 4 years of relevant experience, along with the required minimum years of work experience will also be considered.

• Capability to develop and implement strategy.

• Advanced understanding of provider reimbursement and related methodologies, provider relations, or partnership activities.

• Proficiency in leading teams in a matrixed organization and fostering high-performance teams.

• Demonstrated experience in collaborative interactions with provider leaders.

• Accountable leadership with business and financial acumen, empowerment, influential communication, situational leadership, and strategic planning skills.

• Ability to read and understand both written and spoken English.

• Capable of clear and effective communication.

• Physical ability to stoop and bend, sit and/or stand for long periods, perform repetitive motions, and lift and carry files and business materials.

• Compliance with PacificSource privacy policy and HIPAA laws and regulations.

🏝️ Benefits

• Equal opportunity employment.

• Work-from-home arrangement.

• Coaching and training programs.

• Employee engagement and cultural enhancement initiatives.

• Opportunities for career and staff development.

• Approximately 15% travel opportunity.