Senior Vice President-Claims and Enrollment (Primarily Remote, North Carolina Based)

The Senior Vice President of Healthcare Claims Management is a key leadership role responsible for overseeing all aspects of claims processing operations, encounter submission and health plan enrollment. This is a strategic position that drives process improvement initiatives, ensures compliance with contract requirements and industry standards, fosters a positive culture, and impacts the organization’s success in delivering high-quality healthcare services to our members.

The successful candidate hired for the position, will be required to work onsite at the Alliance Home office (Morrisville, North Carolina), at minimum one day a week, as approved by their supervisor. 

Responsibilities & Duties

Strategic Leadership and Planning

• Develop and implement strategic plans for optimizing operations within the Department
• Align department activities with organizational goals and priorities
• Manage the Department budget and develop strategic plans for ongoing quality improvement

 Team Management

• Work with PODS to maintain and retain a highly qualified and well-trained workforce  
• Ensure staff are well trained in and comply with all organization and department policies, procedures, and business processes
• Ensure the department has the needed tools and resources to achieve organizational goals and to support employees and ensure compliance with licensure, regulatory, and accreditation requirements
• Actively establish and promote a positive, diverse, and inclusive working environment that builds trust  
• Ensure all staff are treated with respect and dignity
• Ensure standards are transparent and applied consistently, impartially, and ethically over time and across all staff members
• Work to resolve conflicts and disputes, ensuring that all participants are given a voice
• Set goals for performance and deadlines in line with departmental and organization goals and vision
• Effectively communicate feedback and provide ongoing coaching and mentoring to staff and support a learning environment to advance team skills and professional development
• Cultivate and encourage efforts to expand cross-team collaboration and partnership
• Foster a culture of continuous improvement, accountability and collaboration

Department Operations

• Identify opportunities for process improvement and automation in the Department and in cross functional workflows
• Streamline workflows to enhanced efficiency and reduce errors
• Oversee the development of processes and/or systems for claims and encounter related initiatives/programs, and/or regulatory changes/requirements
• Oversee the development of membership eligibility for state enrollment and ensure adherence to State guidance
• Direct monitoring of Medicaid eligibility requirements including any reports related to member …