AVP, Out of Network Solutions

JOB SUMMARY: This position leads, plans, develops and directs all aspects of respective cost centers, functions and/or processes within the MRA (Medical Reimbursement Analysis) department. In addition this position regularly partners with senior management to define and execute short and long term business goals to grow the business and ensure operating efficiencies.

JOB ROLES AND RESPONSIBILITIES:
1. Direct the daily operations of assigned business units, to ensure consistent delivery of quality results, operational efficiency and attainment of expectations set forth by internal and external clients. Complete analysis to drive effective problem solving and innovation to processes to include business process re-engineering, automated solutions and overall product and service excellence.
2. Provide leadership for multiple sites across the department through real time management and mid & long range forecasting. Support and align succession planning and business strategy.
3. Establish, implement and maintain departmental performance standards and strategic planning in support of compliance, service and savings to maximize all opportunities to strengthen the customer experience
4. Manage execution of the MRA (DIS) Services objectives through team members in a timely, cost effective manner.
5. Develop and maintain strong relationships both internally and externally, including but not limited to open communication amongst all departments within the organization to ensure company and department goals are consistently met.
6. Develop and maintain action plans and processes to monitor andimprove retained savings based on requirements outlined by the primary client and other payer clients
7. Oversee execution and completion of complex service and claims issues, resolving them timely, effectively and with minimal supervision.
8. Direct the budget process and financial planning for the assigned cost centers and assure adherence to the budget plan and balance cost containment with department needs and customer satisfaction as a high priority.
9. Serve as business sponsor for Agile application development projects and other associated client implementation initatives or related business projects driving improved performance, processes and quality
10. Participate in active dialogue with sales, account management and regulatory on a scheduled basis in support of the existing and proposed product portfolio.
11. Select, develop, and evaluate staff to ensure the efficient operation of department.
12. Collaborate, coordinate, and communicate across disciplines and departments.
13. Ensure compliance with HIPAA regulations and requirements.
14. Demonstrate Company's Core Competencies and values held within.
15. Please note due to the exposure of PHI sensitive data -- this role is considered to be a High Risk Role.
16. The position responsibilities outlined above are in no way to be construed as all encompassing. Other duties, responsibilities, and qualifications may be required and/or assigned as necessary.

JOB SCOPE:
This position is a key leadership role in the orginization, supporting senior management, and has ownership over product performance. The role requires strong communication skills as well as the effective coordination of client requests to achieve outlined business goals. The incumbent works independently under minimal supervision and with considerable discretion to make decisions that affect the day to day operations of the department. The management of day to day operations focuses on operating decisions at the project or functional level of his/her assigned areas of responsibility. The incumbent uses an extensive range of knowledge to complete responsibilities, basing decisions on sound logic and rationale; choosing the best alternative based on consideration of pros, cons, tradeoffs, timing and available resources; and making decisions on problems and issues requiring immediate attention or are complex functional issues. This is a people management role with authority for hiring, discipline, performance management, coaching, mentoring, etc.