The Director of Member Services is responsible for overseeing the performance of the Medicaid line of business, with a focus on financial performance and membership growth. The Director will oversee all aspects of Medicaid member programs, including payment reconciliation, member retention, and data analytics. Accountable for management of the Member Services team, process development, program administration, interdepartmental communication, member communications, payor relations, and compliance with State and Federal regulatory requirements.
ESSENTIAL DUTIES AND RESPONSIBILITIES
This list may not include all of the duties that may be assigned.
- Lead the development and execution of an operational strategy for reconciliation and clearance of capitated payments across the enterprise. Evaluate financial performance ensuring receipt of payment for all patients assigned to or seen by the Company monthly.
- Develop and execute a strategy for maximizing the monthly retention of Medicaid members assigned to the Company.
- Identify data, technology, and human resource requirements for executing the Member Services strategy.
- Establish regular communications with Medicaid payors to facilitate sharing of information and to improve collaboration.
- Develop and manage outbound communications with Medicaid members.
- Define departmental KPIs, set goals, and track progress towards those goals. Establishes, update member services policies and procedures and monitors and oversees compliance with policies within team members. Mentors and motivate staff to reach established KPI.
- Hire, onboard, develop, evaluate and coach Member Services staff to sustain a strong and diverse team to advance the department. Oversee day-to-day change management activities and regularly analyze measurable performance and KPI’s.
- Collaborate with departmental heads to maintain productivity, quality, and ensure company-wide compliance.
- Assist with special projects and reports.
- Other various duties as assigned, including cross-training in other functional areas.
- Member Services Representative
- Managing 5+ staff
EDUCATION: Minimum of Bachelor’s Degree required with a focus in Health Information Management or Healthcare Administration required. 4 years of experience is commensurate to the education required.
EXPERIENCE: Minimum of 3 years experience in a Medicaid managed care organization highly preferred.
Minimum of 3 years in leadership or management capacity with proven success of implementing change and support of corporate mission required.
KNOWLEDGE, SKILLS AND ABILITIES
- Experienced leadership and expertise in direct management of business operations.
- Knowledge of and experience in developing workflow plans with subsequent training, implementation, and performance analysis as it relates to corporate goals.
- Excellent communicator and team leader capable of influencing peers and employees effectively to achieve stated goals.
- Performance-driven and accountable to establish team and individual goals, monitor and report to senior management.
- The ability to represent the Company both internally and externally to advance organizational goals and initiatives.
- Skilled with interpreting business analytics as well as developing regular reporting for staff, peers, and senior management
- Advanced proficiency in Microsoft Excel (or equivalent application), including the use of pivot tables.
- Basic proficiency in Microsoft Word and PowerPoint (or equivalent applications).
- Understanding of state and federal Medicaid managed care frameworks and regulatory environments.
- Strong analytical and strategic planning skills.
- Excellent public presentation skills.
- Knowledge of Medicaid health care delivery systems.
- Ability to work collaboratively in a highly matrixed organization.
TYPICAL WORKING CONDITIONS
- Non-patient facing
- May be either full time remote/telework or rotate working in the office and remote/telework
- If remote, this job must be U.S. based
- Indoor work; professional office environment
- Operating computer
- Reach outward
- May require sitting or standing for long periods, including stooping, bending, stretching
- Lift up to 10lbs
- Requires manual dexterity sufficient to operate a keyboard, type at 35 wpm, operate copier, and other office equipment
OTHER PHYSICAL REQUIREMENTS
- Sense of sound
- Sense of touch