Operational Excellence Manager, Payment Operations

It's an exciting time to join the WellSense Health Plan, a growing regional health insurance company with a 25-year history of providing health insurance that works for our members, no matter their circumstances.

Job Summary:

The Operational Excellence Manager of Payment Operations is responsible for developing strategies to improve the operational performance of the organization's payment operations, increasing efficiency, and reducing operational costs. This individual identifies areas of improvement overseeing the implementation, monitoring and integration of key projects, initiatives, programs, and processes for payment operations. This individual will develop, maintain, and provide payment operations education, training, and communication in consultation with the management team as appropriate, including key business updates, presentations, and balanced scorecard development/execution.

Our Investment in You:

* Full-time remote work

* Competitive salaries

* Excellent benefits

Key Functions/Responsibilities:

• Design, lead, and implement business improvement initiatives for both the individual teams within payment operations and for the entire payment operations sub-division.
• Acts as liaison across the Health Plan on a variety of subjects including performance, data, reporting, etc.
• Assumes responsibility for planning, monitoring, and integrating activities required for the effective functioning of payment operations teams and departments.
• Acts as an information link across payment operations and across WellSense leadership as appropriate to improve communication and information alignment across teams.
• Has regular contact with staff across all parts of the organization, especially Leadership Team members.
• Prepare monthly payment operations program deliverables such as accomplishments reports, dashboard updates, and initiative status updates.
• Develop, maintain, and conduct payment operations learning and training events within the payment operations team and across the organization.
• Manage and maintain payment operations team resources for employees and managers.
• Develop and maintain payment operations dashboards to track metrics, goals and initiative improvement progress.
• Special projects to increase efficiency and effectiveness of payment operations teams and programs.
• Develops meeting agendas, plans any scheduled retreats, and coordinates communications.
• Other duties as assigned.

Supervision Exercised:

* None

Supervision Received:

* General direction is received weekly or as needed.

Qualifications:

Education Required:

* Bachelor's Degree or the equivalent combination of training and experience, plus 5 years related experience.

Education Preferred:

* AHIMA or other nationally recognized coding certification

Experience Required:

* A minimum of 5 years of related program management/operational experience.

* 10 or more years direct work in claims processing, payment policy, or other payment operations related role.

* 5 or more years' experience working with Medicare and Medicaid payment policies and regulatory requirements.

* 5 or more years' experience working with industry standard payment systems and claim processing, such as Facets or Optum pricing and editing software.

Experience Preferred/Desirable:

* Experience developing dashboards/reports utilizing Tableau or equivalent software.

* Experience designing training documentation and knowledge of effective learning methods.

Required Licensure, Certification or Conditions of Employment:

* Successful completion of pre-employment background check

Competencies, Skills, and Attributes:

* Effective collaborative and proven process improvement skills.

* Excellent judgment and discretion, including a proven ability to handle highly sensitive and confidential information.

* Ability to negotiate enterprise solutions with other departments that work interdepartmentally.

* Ability to respond to constantly changing circumstances, work under short deadlines, and handle a necessarily ambiguous role required.

* Comprehension and appreciation of the complexities inherent in an organization and of its corresponding corporate culture.

* Strong oral and written communication skills; ability to interact within all levels of the organization.

* A strong working knowledge of Microsoft Office products.

* Demonstrated ability to successfully plan, organize, and manage projects.

* Detail oriented, excellent proof reading, and editing skills.

Working Conditions and Physical Effort:

• Work is normally performed in a typical interior/office work environment.
• No or very limited physical effort required. No or very limited exposure to physical risk.

About WellSense

WellSense Health Plan is a nonprofit health insurance company serving more than 740,000 members across Massachusetts and New Hampshire through Medicare, Individual and Family, and Medicaid plans. Founded in 1997, WellSense provides high-quality health plans and services that work for our members, no matter their circumstances. WellSense is committed to the diversity and inclusion of staff and their members.

Qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, sexual orientation, gender identity, disability or protected veteran status. WellSense participates in the E-Verify program to electronically verify the employment eligibility of newly hired employees