Imagine Health
  • Cottonwood Heights, UT, USA
  • Full Time

Summary

In the role of Director, Provider Operations, you will be responsible for overseeing all aspects of system design and provider contract configuration and ongoing maintenance. Additionally, you will have direct oversight of provider data management and credentialing functions for a growing number of provider contracts throughout the country.  Candidates for this role will be required to possess both breadth and depth of experience in the operational management of provider contracts, including the loading of contracts, data management and related quality measures, provider directories, demographics, etc.

Duties and Responsibilities

  • Utilize domain expertise, including broad knowledge of provider contract management and claims repricing applications, to interpret and operationalize complex traditional commercial contracts and Medicare reimbursement terms. 
  • Manage an emerging team of provider contract management, data management, and credentialing professionals.
  • Work across functional areas (Claims, Provider Engagement and Contracting, Member Service, Client Service, etc.) to understand their day-to-day needs, resolving escalated issues, and ensuring timely and accurate configuration and performance of the enterprise platform.
  • Develop and execute on a strategy that will enable high levels of customer service and support to our providers and customers, to scale efficiently and meet the highly complex demands of the organization.
  • Create and drive execution of operational workflows and logistics in a way that is iterative, data-driven, and with an eye towards technology-enabled scalability.
  • Develop a robust quality assurance process to reduce avoidable errors within claims processing due to contract configuration and provider data management.
  • Work to combine both processes and personnel located throughout several national offices, establishing a cohesive team and working to outline best practices and standard operating procedures for an essential operating unit.
  • Rely on previous experience as IT application business lead responsible for defining business requirements, collaborating with application development teams, and leading testing/training activities related to expanding operational area.
  • Other duties as assigned.

Education and Experience

  • Bachelor's Degree in Business, Health Administration or other related area
  • 5 years of healthcare provider delivery system or healthcare insurance experience
  • 5 years of management experience, with direct experience working with provider-related contracting and partnership models

Specialized Skills/Knowledge

  1. Ability to thrive in a fast-paced entrepreneurial company and a fast-evolving market.
  2. Proven leadership and management skills.
  3. Must be familiar with Medicare and Commercial reimbursement methodologies
  4. Must possess strong verbal and written communication skills.
  5. Must be able to handle complex contract negotiations.
  6. Must possess strong analytical and problem-solving skills.
Imagine Health
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