Director of Claims and Enrollment Operations

job
  • Samaritan Health Services
Job Summary
Location
Corvallis ,OR 97333
Job Type
Contract
Visa
Any Valid Visa
Salary
PayRate
Qualification
BCA
Experience
2Years - 10Years
Posted
04 Dec 2024
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Job Description
  • Samaritan Health Plans (SHP) provides health insurance options to Samaritan employees, community employers, and Medicare and Medicaid members. SHP operates a portfolio of health plan products under several different legal structures: InterCommunityHealth Plans, Inc. (IHN) is designated as a regional Coordinated Care Organization (CCO) for Medicaid beneficiaries; Samaritan Health Plans, Inc. offers Medicare Advantage, Commercial Large Group, and Commercial Large Group PPO and EPO plans; SHP is also the third-party administrator for Samaritan Health Services' self-funded employee health benefit plan.
    As part of an Integrated Delivery System, Samaritan Health Plans is strategically and operationally aligned with Samaritan Health Services' mission of Building Healthier Communities Together.
  • We are open to remote out of state work in any of our approved states: Alabama, Alaska, Arizona, Arkansas, Connecticut, Florida, Georgia, Idaho, Indiana, Iowa, Kansas, Kentucky, Louisiana, Michigan, Mississippi, Missouri, Montana, Nebraska, Nevada, New Hampshire, New Mexico, North Carolina, Oklahoma, Rhode Island, South Carolina, South Dakota, Tennessee, Texas, Utah, Virginia, West Virginia, or Wisconsin
  • JOB SUMMARY/PURPOSE
    • Oversees and manages the strategic operations of the Claims, Enrollment, and Provider Data Management departments. Ensures the accuracy, efficiency, and compliance of all related processes, driving improvements and innovations to support organizational goals. Works closely with internal and external stakeholders to ensure service excellence, operational efficiency, and regulatory compliance.
  • EXPERIENCE/EDUCATION/QUALIFICATIONS
    • Bachelor's degree in Healthcare Administration, Business Administration, or a related field; or equivalent experience required. Master's degree preferred.
    • Five (5) years of experience in claims processing, enrollment, and provider data management within a managed care organization or a similar healthcare setting required.
    • Three (3) years leadership experience required.
    • Experience with healthcare regulations, including Medicare and Medicaid, required.
    • Experience in healthcare management systems and data analytics tools required.
  • KNOWLEDGE/SKILLS/ABILITIES
    • Leadership - Inspires, motivates, and guides others toward accomplishing goals. Achieves desired results through effective people management.
    • Conflict resolution - Influences others to build consensus and gain cooperation. Proactively resolves conflicts in a positive and constructive manner.
    • Critical thinking - Identifies complex problems. Involves key parties, gathers pertinent data and considers various options in decision making process. Develops, evaluates and implements effective solutions.
    • Communication and team building - Leads effectively with excellent verbal and written communication. Delegates and initiates/manages cross-functional teams and multi-disciplinary projects.
  • PHYSICAL DEMANDS
    • Rarely
      (1 - 10% of the time)
      Occasionally
      (11 - 33% of the time)
      Frequently
      (34 - 66% of the time)
      Continually
      (67 - 100% of the time)
      LIFT (Floor to Waist: 0"-36") 0-20 Lbs
      LIFT (Knee to chest: 24"-54") 0 - 20 Lbs
      LIFT (Waist to Eye: up to 54") 0 - 20 Lbs
      CARRY 1-handed, 0 - 20 pounds
      CARRY 2-handed, 0 - 20 pounds
      KNEEL (on knees)
      BEND FORWARD at waist
      CLIMB - STAIRS
      STAND
      WALK - LEVEL SURFACE
      ROTATE TRUNK Standing
      REACH - Upward
      PUSH (0-20 pounds force)
      PULL (0-20 pounds force)
      SIT
      ROTATE TRUNK Sitting
      REACH - Forward
      MANUAL DEXTERITY Hands/wrists
      FINGER DEXTERITY
      PINCH Fingers
      GRASP Hand/Fist
      None specified
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