Director Insurance Plan Services
Tenet (Dallas, Texas)

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Are you looking to be a leader of a new and innovative team?  Are you motivated by challenges and positive changes?  Then this is the position for you!  The National Insurance Center in Frisco, TX is looking for a Insurance Plan Services Director.  The responsibilities of the Director include: Provides operational direction to assigned unit.  Coordinates organization related issues with Human Resources and Legal. Analyzes and identifies problems, determines cause and desired resolution.  Takes steps necessary to implement resolution.  Solves escalated problems related to his/her areas of assignment, and maintains a detailed knowledge of functions in these areas. Conducts regularly scheduled meeting with managers, site directors, Tenet support departments, vendors and payors to communicate issues regarding compliance with established procedures and overall work unit effectiveness. Develops strategies and mechanisms to ensure proper and timely follow-up of claim denials and accurate dispute code information in the Dispute Claims Management system (DCM); ensures a timely appeals process on denied claims for less than expected reimbursement. Prepares annual budget (both operating and capital) and implements the approved budget goals.  Reports and justified variances from the budgeted level. Directs the development of tactical plans and operating budgets to achieve strategic PFS goals; monitor progress toward goals throughout the year.  Provides on-going guidance and feedback to staff about denial reasons, appeals and their outcomes, and managed care contractual requirements. Participates in Payor meetings. Maintains a thorough understanding of Managed Care concepts including HMO, PPO, POS, EPO and capitation. Manages the aging of disputed A/R to ensure timely follow up and decision-making Hires trains and develops assigned management and others.  Partners with Human Resources to maintain consistent policy and manages expectations with recruiting department to ensure staffing levels are met.  Conducts performance evaluations, recommends salary adjustments and takes disciplinary action as necessary.

Qualifications:

4 year college degree in Healthcare Administration, Business or related area or equivalent experience. MBA/ CPA preferred 6 - 9 years experience in Healthcare Administration or Business Office 2 – 4 years Dispute Resolution experience Advanced knowledge of healthcare A/R, collections, insurance, government programs and appeals Advanced knowledge of Compliance Regulations and Guidelines Advanced knowledge of healthcare reimbursement methodologies Excellent working knowledge of Patient Financial Services operations with specific focus on Inpatient and Outpatient Managed Care and Commercial payors (i.e., Medicare regulations and compliance; HIPAA) Proficient in Microsoft Office (Word and Excel) Advanced writing skills Ability to provide advanced customer service Proven ability in human resource management, including training and coaching staff Ability to plan and implement process improvements Ability to multi-task Strong leadership and organizational skills Strong negotiation skills