Director Out of Network Services

Company: Zelis Healthcare, LLC
Location: Plano
Posted on: January 23, 2025

Job Description:

Position Overview: The Director of Out of Network Services is responsible for overseeing the operations and performance of the Out of Network Post Pay Solutions department. The Director ensures that the department meets the quality, productivity, and compliance standards set by the company and the clients. The Director also develops and implements strategies to improve the efficiency and effectiveness of the out of network post pay processes and systems.Key Responsibilities:

• Manage the day-to-day operations of the out of network post pay department, including staff supervision, workload distribution, performance evaluation, and coaching.
• Monitor and analyze the key performance indicators of the department, such as retained savings, turnaround time, quality assurance, and customer satisfaction.
• Identify and implement opportunities for process improvement, cost reduction, and service enhancement.
• Ensure compliance with the company policies, procedures, and contractual obligations related to out of network claims.
• Collaborate with other departments, such as network solutions, customer service, and finance, to resolve complex or escalated issues and ensure customer satisfaction.
• Develop and maintain positive relationships with external stakeholders, such as providers, payers, and regulators.
• Stay abreast of the industry trends, best practices, and regulatory changes related to out of network claims.
• Prepare and present reports and recommendations to senior management and clients on the performance and improvement of the out of network post pay team.Qualifications:
  • Bachelor's degree in business administration, health care management, or related field.
  • Minimum of 10 years of experience in health care claims processing, with at least 5 years in a managerial or supervisory role.
  • Extensive knowledge of out of network claims policies, procedures, and regulations.
  • Strong analytical, problem-solving, and decision-making skills.
  • Excellent communication, interpersonal, and leadership skills.
  • Proficient in Microsoft Office and claims processing software.
  • Expertise in fully insurance & self insured market segments
  • Experience managing client relationshipsLocation and Workplace Flexibility:We have offices in Atlanta GA, Boston MA, Morristown NJ, Plano TX, St. Louis MO, St. Petersburg FL, and Hyderabad, India. We foster a hybrid and remote friendly culture and all of our employee's work locations are based on the needs of the position and determined by the Leadership team. In-office work and activities, if applicable, vary based on the work and team objectives in accordance with Company policies.Zelis is modernizing the healthcare financial experience by providing a connected platform that bridges the gaps and aligns interests across payers, providers, and healthcare consumers. This platform serves more than 750 payers, including the top 5 national health plans, BCBS insurers, regional health plans, TPAs and self-insured employers, and millions of healthcare providers and consumers. Zelis sees across the system to identify, optimize, and solve problems holistically with technology built by healthcare experts - driving real, measurable results for clients.Commitment to Diversity, Equity,Inclusion, and BelongingAt Zelis, we champion diversity, equity, inclusion, and belonging in all aspects of our operations. We embrace the power of diversity and create an environment where people can bring their authentic and best selves to work. We know that a sense of belonging is key not only to your success at Zelis, but also to your ability to bring your best each day.Equal Employment Opportunity Zelis is proud to be an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.We encourage members of traditionally underrepresented communities to apply, even if you do not believe you 100% fit the qualifications of the position, including women, LGBTQIA people, people of color, and people with disabilities. Accessibility SupportWe are dedicated to ensuring our application process is accessible to all candidates. If you are a qualified individual with a disability or a disabled veteran and require a reasonable accommodation with any part of the application and/or interview process, please email .SCAM ALERT: There is an active nationwide employment scam which is now using Zelis to garner personal information or financial scams. This site is secure, and any applications made here are with our legitimate partner. If you're contacted by a Zelis Recruiter, please ensure whomever is contacting you truly represents Zelis Healthcare. We will never asked for the exchange of any money or credit card details during the recruitment process. Please be aware of any suspicious email activity from people who could be pretending to be recruiters or senior professionals at Zelis.

Keywords: Zelis Healthcare, LLC, Frisco , Director Out of Network Services, Executive , Plano, Texas