Job Summary:
The Senior Director, Market Liaison Support Services (MLSS), is responsible for leading advanced troubleshooting, root cause analysis, and resolution of operational issues across all products. This role will drive process improvements, ensure operational effectiveness, and build strong relationships with key stakeholders. The Senior Director will work cross-functionally to identify and remediate process gaps, ensuring that all operational processes are accurate, timely, and aligned with organizational goals.
Essential Functions:
- Foster strong working relationships with Market leadership as the primary point of contact for Operations to drive process improvements and enhance collaboration and outcome improvements
- Lead MLSS engagement within JOC forums for key Providers to professionally represent Operations performance and trending
- Lead and train the team in advanced root cause analysis techniques, ensuring that issues are thoroughly and accurately investigated, documented, and resolved. Develop infrastructure to perform, document, and report findings to providers, Provider Representatives, and Enterprise-wide leaders
- Collaborate cross-functionally to identify and close process gaps, ensuring that all operations processes, including system configuration, provider information management, credentialing, claim processing and adjustment, enrollment, and robotic processing automation, are optimized for efficient and accurate outcomes
- Monitor the accuracy and timeliness of all operational remediation processes, including ticket oversight ensuring tickets meet established standards and service level agreements (SLAs). Provide leadership and direction to ensure departmental and divisional goals and strategies are successfully achieved.
- Serve as a cross-functional Operations Liaison, supporting Operations initiatives and ensuring alignment with organizational strategies
- Assist in strategic and business planning, including the identification and implementation of new initiatives
- Support and drive the continuous improvement of Operations outcomes through accurate root cause analysis, solutioning, facilitation of remediation, and continual feedback on management information dashboards, ensuring that data is accurately reported and used to inform decision-making
- Engage direct reports and MLSS team through consistent performance feedback, effective performance management programs, and continuous development opportunities. Monitor and document processing accuracy, productivity levels, and ensure compliance with SLAs.
- Identify, develop, and generate Operations reports specific to market needs, ensuring that all reporting is accurate, timely, and actionable
- Lead critical department administration efforts, including preparing and monitoring departmental budgets, developing and implementing policies and procedures, and ensuring appropriate staff training
- Perform any other job duties as requested
Education and Experience:
- Bachelor’s degree in business administration, healthcare management, a related field or equivalent years of relevant work experience is required
- Seven (7) years of healthcare operations experience in insurance, managed care, or a related industry is required
- Five (5) years of leadership experience is required, to include managing complex operations
- Extensive experience in data analysis, process mapping, and performance measurement is required
- Experience with LEAN/Six Sigma methodologies is preferred
Competencies, Knowledge, and Skills:
- Strong knowledge and understanding of medical claim processing is required
- Working knowledge of provider credentialing, information management, medical billing processes, CPT, HCPCS, ICD-10 coding, and membership enrollment operations is preferred
- Ability to conduct independent analysis, attention to detail, and collaboration across multiple departments
- Effective relationship management skills, with the ability to build and maintain strong working relationships in a matrix environment
- Proficient in technical writing, executive summaries, and presentation skills. Excellent verbal communication, including phone etiquette
- Ability to effectively organize and prioritize multiple initiatives, ensuring that target dates and SLAs are communicated and met
- Skilled in contributing to and executing department strategy, with a focus on leadership, team development, and achieving departmental goals
- Advanced proficiency in Microsoft Excel and PowerPoint is required. Experience with other data analysis and reporting tools is a plus
Licensure and Certification:
- LEAN/Six Sigma certification is preferred
Working Conditions:
- General office environment; may require sitting or standing for extended periods of time
- Occasional travel may be required, estimated at less than 10%
Compensation Range:
CareSource takes into consideration a combination of a candidate’s education, training, and experience as well as the position’s scope and complexity, the discretion and latitude required for the role, and other external and internal data when establishing a salary level. We are highly invested in every employee’s total well-being and offer a substantial and comprehensive total rewards package.
Compensation Type (hourly/salary):
Salary
Organization Level Competencies
This job description is not all inclusive. CareSource reserves the right to amend this job description at any time. CareSource is an Equal Opportunity Employer, including disability and veteran status. We are committed to a diverse and inclusive work environment.