MontereyParkRecruiter Since 2001
the smart solution for Monterey Park jobs

Senior Director, Operations - Provider Experience

Company: Blue Shield of CA
Location: Monterey Park
Posted on: May 16, 2020

Job Description:

At Blue Shield of California we are parents, leader, students, visionaries, heroes, and providers. Everyday we come together striving to fulfill our mission, to ensure all Californians have access to high-quality health care at a sustainably affordable price. For more than 80 years, Blue Shield of California has been dedicated to transforming health care by making it more accessible, cost-effective, and customer-centric. We are a not-for-profit, independent member of the Blue Cross Blue Shield Association with 6,800 employees, more than $20 billion in annual revenue and 4.3 million members. The company has contributed more than $500 million to Blue Shield of California Foundation since 2002 to have a positive impact on California communities. Blue Shield of California is headquartered in Oakland, California with 18 additional locations including Sacramento, Los Angeles, and San Diego. Were excited to share Blue Shield of California has received awards and recognition for LGBT diversity, quality improvement, most influential women in corporate America, Bay Areas top companies in volunteering & giving, and one of the worlds most ethical companies. Here at Blue Shield of California, were striving to make a positive change across our industry and the communities we live in Join us!

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 Blue Shield of California 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 for:

Strategic 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 Blue Shield compliance with various state and federal laws and accreditation standards.

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 Blue Shield of California 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 for:

Strategic 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.

External hires must pass a background check/drug screen. Qualified applicants with arrest records and/or conviction records will be considered for employment in a manner consistent with Federal, State and local laws, including but not limited to the San Francisco Fair Chance Ordinance. All qualified applicants will receive consideration for employment without regards to race, color, religion, sex, national origin, sexual orientation, gender identity, protected veteran status or disability status and any other classification protected by Federal, State and local laws.

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

Click here to apply!

Didn't find what you're looking for? Search again!

I'm looking for
in category
within


Other Executive Jobs


Account Manager
Description: Job Description br br Job Title: Account Manager br br FLSA Status:Exempt br br Department:Sales br br Summary br br The Account Manager is responsible for selling and presenting Varonis (more...)
Company: Varonis
Location: Los Angeles
Posted on: 05/29/2020

Executive Director
Description: We're looking for a candidate to fill this position in an exciting company. ul li Operational planning and budgeting li Ensuring organizational compliance with legal, regulatory and accreditation (more...)
Company: Bristol Hospice LLC
Location: Riverside
Posted on: 05/29/2020

Sr. Product Manager - Imaging Software
Description: The Sr. Product Manager, Imaging Software, will be a key team member that will actively manage the product life cycle of new and existing Aperio ePathology products, including image management and viewer (more...)
Company: Danaher
Location: Vista
Posted on: 05/29/2020


Treasury Manager
Description: We are looking for a Treasury Manager that desires to make an impact on a fast growing organization. Reporting to the Director of Corporate Finance, the Treasury Manager is an integral member of the Corporate (more...)
Company: Sonos
Location: Santa Barbara
Posted on: 05/29/2020

Executive Director, Service Lines & Physician Alignment - MCWHLB
Description: At MemorialCare Health System, we believe in providing extraordinary healthcare to our communities and an exceptional working environment for our employees. Memorial Care stands for excellence in Healthcare. (more...)
Company: Long Beach Memorial Medical Center
Location: Long Beach
Posted on: 05/29/2020

Manager, Warehouse
Description: br br Company Overview HD Supply NASDAQ:HDS www.hdsupply.com is one of the largest industrial distributors in North America. The company provides a broad range of products and value-add services (more...)
Company: HD Supply
Location: Escondido
Posted on: 05/29/2020

Vice President (VP) of Quality and Patient Safety (LBMMC), Quality Assurance - FT/Days
Description: At br br MemorialCare Health System, we believe in providing extraordinary healthcare to br br our communities and an exceptional working environment for our employees. br br Memorial Care (more...)
Company: Long Beach Memorial Medical Center
Location: Long Beach
Posted on: 05/29/2020

ITIL Service Now Incident Manager
Description: Role Biovia LIMS Location Thousand Oaks, CA 5 years of CIMS Biovia LIMS preferred implementationsupportmaintenance experience. Must
Company: Peoplentech
Location: Thousand Oaks
Posted on: 05/29/2020

Director, Global Package Development
Description: We're looking for a candidate to fill this position in an exciting company. ul li Drive innovation by presenting new packagingconcepts, technologies and delivery systems to support new Marketing,Product (more...)
Company: The Est--e Lauder Companies Inc.
Location: Culver City
Posted on: 05/29/2020

Managing Director- (Division President) Brokerage Commercial Real Estate
Description: We're looking for a candidate to fill this position in an exciting company. ul li --Manage the process of proposals to clients
Company: Rosano Partners, LLC
Location: Los Angeles
Posted on: 05/29/2020

Log In or Create An Account

Get the latest California jobs by following @recnetCA on Twitter!

Monterey Park RSS job feeds