Vice President of Service Operations

Shift: Monday - Friday 8:00am – 5:00pm

Company Job Description/Day to Day Duties:

You, as the Vice President of Service Operations will be held responsible to direct the provider operations, government program operations, business process management, claims, customer service call center, and enrollment and billing functions of the company.

Essential Duties:

• Direct the daily operations of Provider Operations, Government Program Operations, Business Process Management, Claims, Enrollment & Billing, and Member Service functions to ensure cost effective, efficient, and member centric service. 

• Ensure the fair, accurate, consistent and timely processing of claims in compliance with member policies, provider contracts, and government regulations.

• Ensure BCI maintains current and accurate Provider File information.

• Ensure accurate enrollment of members and timely distribution of membership cards. Ensure premiums are billed and membership is reconciled and premium payments received before releasing claims for payment. Ensure Group Administrators and/or Individuals are contacted in order to collect past due premiums. Ensure that questions regarding membership status and billings are answered accurately and in a timely manner. 

• Ensure Provider and Customer inquiries regarding claims status, benefits, and eligibility are answered accurately, timely, and in a manner that reflect excellent customer service. Ensure Provider inquiries for Medicare Advantage Providers are answered accurately, timely, and in a manner that reflects excellent customer service and consistent with Medicare regulations.

• Responsible for the maintenance of system of clinical rules and edits necessary to protect policy holders against improper billing practices.

• Provide oversight for provider network management activities related to provider information management, credentialing, risk score optimization, and provider appeals.

• Develop and implement business plans assuring the delivery of cost-effective high quality medical and administrative services for Medicare and Medicaid members. Ensure revenue management and reconciliation systems that contribute to profitability and ensure compliance with governmental regulations.

• Provide support for effective corporate-wide operations by participating as a member of the Executive Staff.

• Ensure the highest quality of service is provided in an efficient manner by conforming to and complying with the goals and objectives of the company.

• Perform other duties as requested by the Executive Vice President Healthcare Operations & IT.

Management Accountabilities:  

• Establish division objectives that support corporate goals and produce regular status reports.

• Prepare an operating budget that reflects the forecasted needs of the department and control expenditures to assure adherence to approved budgets. Manage expenses not to exceed the budget

• Ensure effective workflows, maximize system efficiencies, monitor quality performance measures and confirm appropriate completion of work assignments. Make recommendations for change as appropriate.

• Approve personnel actions such as hiring, disciplinary, termination and/or salary recommendations.

• Participate in training, coaching and motivation of employees including career path development. Assess individual employee performance and conduct timely performance appraisals.

• Promote teamwork, discussion, and cooperation among staff and other departments. Ensure timely communication and sharing of information with team members.

• Work with staff to resolve work-related issues and concerns. Promote a respectful and diverse workplace.

• Develop and maintain departmental policies and procedures.