Senior Director, Product Configuration & Implementation

Company: Inland Empire Health Plans
Location: Rancho Cucamonga
Posted on: January 26, 2023

Job Description:

Press Tab to Move to Skip to Content Link Under the direction of the Chief Financial Officer and in collaboration with the Director of Strategic Decision Support, the Senior Director of Product Configuration & Implementation is ultimately responsible for the structure, staffing, best practices and standardization of the Product Configuration and Implementation Department. -
This includes:
- Collaborating with Director of Strategic Decision Support to implement new governance process.
- Developing formal communication channels with impacted business units, enable escalations, and expedite decision making.
- Establishing ownership and driving accountability to ensure IEHP is proactively responding to new benefits and code set changes from regulatory bodies (for all product lines). -
- Leading cross-functional implementation of new benefit and clinical procedure code changes by gathering the right stakeholders and thought leaders within the organization to make decisions in planning, prioritizing, and navigating ambiguous regulatory directives. -Major Functions (Duties and Responsibilities)1. Serve as the primary resource to assess and operationalize new benefit changes and additions for Medi-Cal, Medicare, and commercial products (Covered CA) and its underlying code sets impacting claims payments. -
2. Dive and organization the structure, staffing, best practices and standardization of the Product Configuration and Implementation Department.
3. Work in collaboration with multiple business units including, but not limited to: Provider Contracting, UM/Pre-authorizations, Claims/Encounters, Benefits Configuration, Actuarial, Provider Communication, Legal/Compliance, IT, Quality to implement changes/additions to benefits.
4. Define metrics, drives problem solving and root-cause analysis to systematically improve and sustain operations.
5. Analyze plan designs, coverage certificates, and regulatory requirements and provide rigorous interpretation and translation into coverage documentation and benefit configuration requirements -
6. Lead the prioritization and manages the implementation of new benefits as outlined by DHCS, CMS and Covered CA and holds the "source of truth" for benefit coverage within IEHP.
7. Provide technical guidance, consultation, and recommendations for improvement of the organization's policies, procedures, and practices for all product lines in relation to benefit coverages and code sets. Ensures appropriate and timely implementation of requirements. -
8. Interface with regulatory agencies and governmental agencies.
9. Meet and communicate regularly with organization-wide operations, non-operations, and clinical leaders to resolve issues.
10. Cultivate and maintain positive working relationships at all levels of the organization to ensure positive collaboration to identify, assess, and prioritize impacts of the benefit changes or additions throughout the organization.
11. Develop plan for scaling the department when new lines of business, for example, Covered CA are introduced.
12. Stay current on regulations, industry trends, current practices, new developments, applicable laws, and legislation. -Major Functions (Duties and Responsibilities) ContSupervisory Responsibilities Leader: Administers Hires, Terminations, and Performance Reviews Experience QualificationsA minimum of ten (10) years of experience in a leadership position within the health plan administration function, which includes:
- A minimum of five (5) years of experience in a managed care setting.
- Claims, coding, and configuration experience in a managed care setting.
- Demonstrated experience with Covered CA/Medicare product requiredPreferred ExperienceDemonstrated experience with Medi-Cal product preferred.Education QualificationsBachelor's degree in a related field from an accredited institution required.Preferred EducationMaster's degree in a related field from an accredited institution preferred. -Professional CertificationAmerican Academy of Professional Coders (AAPC) and American Health Information Management Association (AHIMA) certifications preferred.Professional LicensesDrivers License Required Yes, must have a valid California Driver's license and valid automobile insurance. Must qualify and maintain driving record to drive company vehicles based on IEHP insurance standards of no more than three (3) points. Knowledge RequirementDemonstrated knowledge of:
- Managed care, commercial, government programs, or other product lines.
- Healthcare, health plans and/or health plan accreditation principles and practices, in directing operations within the organization. -
- Regulatory and compliance requirements related to commercial products, including but not limited to, the California Knox-Keene Healthcare Service Plan Act and Regulations. Health plan operations in a commercial plan environment. Skills RequirementExcellent skills in:
- Interpersonal communication with a proven ability to interact effectively at all levels of the organization.
- Verbal and written communication.
- Organization, process, and project management.
- Strong organizational skills and attention to detail.
- Analysis and synthesis.
- Communicating data requirements with actuaries and configuration team and communicate technical requirements (from a business perspective) with System vendors (or IT Department).Abilities RequirementAbility to:
- Implement change in a consultative approach and maneuver in a matrix reporting environment.
- Work independently and collaboratively within a team environment and matrix management structure to deliver results.
- Manage multiple products within a health plan and multiple projects with competing deadlines and changing priorities with proven execution against aggressive objectives.
- Partner with external partners to execute goals and initiatives of the organization.
- Work in a complex, rapidly evolving environment which requires high-level initiative, and judgment necessary to bring resolution to sensitive issues.
- Communicate effectively to a variety of audiences in small or large group setting.Commitment to Team CultureThe IEHP Team environment requires a Team Member to participate in the IEHP Team Culture. A Team Member demonstrates support of the Culture by developing professional and effective working relationships that include elements of respect and cooperation with Team Members, Members and associates outside of our organization.Working ConditionsNormal business hours - Hybrid Position Hybrid Physical Requirements Hearing: One-on-One - FREQUENTLY Near Visual Acuity - FREQUENTLY Communicate: Information/ideas verbally - FREQUENTLY Regular and reliable attendance - CONSTANTLY Memory - FREQUENTLY Understand and follow direction - FREQUENTLY Keyboarding: 10-Key - FREQUENTLY Keyboarding: Touch-Screen - FREQUENTLY Keyboarding: Traditional - FREQUENTLY Pay rate will commensurate with experienceInland Empire Health Plan (IEHP) is the largest not-for-profit Medi-Cal and Medicare health plan in the Inland Empire. We are also one of the largest employers in the region. With a provider network of more than 7,000 and a team of more than 2,500 employees, IEHP provides quality, accessible healthcare services to more than 1.5 million members. And our Mission, Vision, and Values help guide us in the development of innovative programs and the creation of an award winning workplace. As the healthcare landscape is transformed, we're ready to make a difference today and in the years to come. Join our Team and make a difference with us! IEHP offers a competitive salary and a benefit package with a value estimated at 35% of the annual salary, including medical, dental, vision, team bonus, and state pension plan.
Nearest Major Market: Riverside
Nearest Secondary Market: Los Angeles

Keywords: Inland Empire Health Plans, Rancho Cucamonga , Senior Director, Product Configuration & Implementation, Executive , Rancho Cucamonga, California