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Senior Director, Operations - Provider Experience

Company: Blue Shield of California
Location: Monterey Park
Posted on: May 14, 2020

Job Description:

Reporting to the VP of Provider, Broker and Shared Service, the role of the Sr. Director, Operations - Provider Experience is critical to the success of Company and the Customer Care department in realizing its goals and objectives.-- This individual will play a key role as part of the Provider, Broker, and Shared Services leadership team in delivering and collaborating on the Provider Experience including leading the provider call centers for all lines of business and provider dispute resolutions for Medicare and Medi-Cal.Specifically the Sr. Director, Operations - Provider Experience role will be accountable forStrategic and Tactical Planning for Provider Experience including-- Provider Call Centers and the Provider Dispute Resolution teams for Medi-Cal and Medicare.--- Manages service, regulatory and financial performance of the Provider Dispute Resolution function for Medi-Cal and Medicare making sure that BSC is compliant at all times.--- Defines and implements organizational structure to facilitate business performance. Ensures optimization of resources by resolving any duplicative improvement efforts and organizational structure overlap.--- Provides-- executive oversight and leadership to Managers responsible for creating and driving implementation of operating plans, which are required to support immediate and long-term business strategies.--- Ensure customer-driven KPIs and goals are in place, which are reflective of and measure our strategic, competitive and regulatory position with ongoing measurement, reporting, and root cause analysis.--- Guides and develops-- near-term operating plans for designated area of responsibility.----- Lead end-to-end process improvements and implements a PDR workflow tool in conjunction with the Clinical team to create efficiencies and to allow us to scale for growth, such as automating processes-- and adoption of self-service portals.--- Regulatory Audits - Provides direction and-- management for Regulatory (DMHC, CDI), Accreditation (NCQA, URAC) and employer group audits; includes documentation of evidence supporting compliance, the onsite file review and the interview processes and the written response processes.-- --Implements changes based on audit findings along with internal controls to maintain compliance--- Develops enhanced tracking, analytics and reporting of current PDR reasons and resolutions in order to clearly articulate provider pain points to partners in the organization which results in influencing change and service improvements.----- Develops and manages the vendor relationship for provider call handling maintaining service levels, decreasing hand-offs and reducing overall call volume through elimination of non-value add processes and increasing self-service.-- In conjunction with the digital team, make suggestions for increased omni-channel capabilities.--- Provides thought leadership to the Customer Care Leadership Team, and other cross-functional leaders throughout BSC operational issues.----- Provides effective leadership in attracting and retaining top talent to drive the business results for this business segment-- ----- Responsible for the interpretation and translation of regulatory and accreditation requirements into operational procedures that support Company compliance with various state and federal laws and accreditation standards.QualificationsEducation/Credentials----- -- -- -- Minimum of 12 years of relevant experience required; 6 years of management experience----- -- -- -- Bachelor's degree----- -- -- -- Masters degree preferred

Keywords: Blue Shield of California, Monterey Park , Senior Director, Operations - Provider Experience, Executive , Monterey Park, California

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