Assistant Director, Configuration & Provider Network Services

Company: The ABA Rule of Law Initiative
Location: Saint Louis
Posted on: September 13, 2020

Job Description:

St. Louis, MO, USA Req #209

Friday, July 31, 2020

Our goals are to provide excellent service, utilize advanced technology, and proficiently deliver results. To accomplish these goals, we constantly seek individuals who look for ways to do things better. We are a company whose  culture   cultivates teamwork, rewards excellence, focuses on quality for every aspect of our business, and promotes community involvement.

Tabula Rasa HealthCare (TRHC) is a leader in providing patient-specific, data-driven technology and solutions that enable healthcare organizations to optimize performance to improve patient outcomes, reduce hospitalizations, lower healthcare costs, and manage risk. Medication risk management is TRHC’s lead offering, and its cloud-based software applications, including EireneRx® and MedWise™, provide solutions for a range of payers, providers and other healthcare organizations.

TRHC empowers our employees to provide excellent service, utilize advanced technology, and proficiently deliver results. Our 32Fundamentals are what we are and who we are. Our culture cultivates teamwork, rewards excellence, focuses on quality for every aspect of our business, and promotes community involvement. As a part of our team, you will help us bring innovative service models to healthcare, improving patient outcomes.

Peak TPA (Peak), a Tabula Rasa HealthCare company, helps PACE organizations manage the business functions that drive the major sources of reimbursement revenue and utilization costs. Peak provides services that optimize financial management and fulfill regulatory requirements for health plan functions. Peak is committed to the PACE model of care and thus to the success of the sponsoring organizations.

Peak TPA is seeking candidates to fill the role of Assistant Director of Configuration & Provider Network Services

This role may be based out of St. Louis, MO or Eden Prairie, MN. If candidates in these areas are not identified, we may consider remote work.

Job Description: Assistant Director of Configuration and Provider Network Services

Summary: Under the guidance of the Director of Implementation & Configuration, the Assistant Director of Configuration and Provider Network Services is the right hand to the Director. This role develops, directs and manages all aspects of Peak’s claim processing systems, training departmental staff, and serves as a liaison to Claims, Sales, Service and Implementations, as well as the Migration Team. S/he will be responsible for ensuring clients benefits and provider contracts/payments are properly loaded and configured to maximize automation and accuracy of data populating downstream extracts such as,and that data is submitted to CMS and states as required for risk adjustment, encounter data, provider 835 payments and internal/external data warehouses

Essential Functions:

System Responsibilities

Assist with the leading of the configuration of client’s rules, benefits, members, and providers in Peak’s system in concert with the Director

Oversee the submission and tracking of support tickets for Peak’s processing system, and report bottlenecks

Ensure policies, procedures and formal delegations are in place to maintain effective coordination and control of configuration, provider network, and regulatory department activities

Ensure that service and product standards are in place and that programs and training are in place to assure consistent achievement of targets

Regularly evaluate policies and procedures to ensure consistent application and effective operation

Evaluate and ensure overall quality of service delivery process and illuminate vulnerabilities early for mitigation

Recommend alternative strategies to improve effectiveness of operations

Establish measures and processes by which to collect, monitor, evaluate, and report on key performance indicators

Ensure the information and data integrity of the processing systems

Continually increase the use of data as a basis for making business decisions

Assist in the exploration and evaluation of in-house or purchased technology solutions for current and future business needs.

Instill and reinforce an outstanding service culture for internal & external customers

Take prompt and decisive corrective action when necessary to ensure achievement of financial, operational, quality and service goals

Management support for business evolution and process improvement

Assist in the evaluation of department readiness and staff preparedness for business evolution and expansion

Assist in the facilitation of process improvement projects identified, prioritized and assigned across the Peak organization

Participate in all phases of project management to make certain that the objectives are accomplished on time and within budget and that risks have been identified and properly mitigated

Facilitate workgroups to identify ways to increase quality and efficiency and business and operations processes

Assure effective communication as organizational changes are implemented

Talent Management

Collaborate with Director, HR, parent company and Peak VP/SVP to attract, develop and retain Peak talent

Provide direct reports with timely and constructive performance feedback

In accordance with company human resource policies and procedures, review, recommend or approve promotions and salary reviews

Advise the management team on client issues.

Ensure all direct reports are fully informed of operational objectives and input is obtained prior to significant operational changes

Conduct regular meetings with Director, direct reports and staff to communicate priorities and coordination of activities

Support company-wide performance planning, coaching, appraisal and discipline programs to ensure consistent, fair, and transparent implementation and compliance with company policies and procedures

Additional Functions:

Assist Director with team meeting agendas, recognition, etc.

Communicate clearly and concisely, with sensitivity to the needs of others

Maintain courteous, helpful and professional behavior on the job; display a willingness and ability to be responsive in a warm and caring manner to all customer groups; consistently cooperates and supports organization in problem solving issues; ensure customer satisfaction; will support the success of the entire team; establish and maintains effective working relationships with co-workers

Follow all Policies and Procedures and HIPAA regulations

Maintain a safe working environment

Maintain the confidentiality of all company procedures, results and information about participants, clients, providers and employees

Assist with special projects as requested by the Director

Supervisory Responsibility: Responsible for daily supervision of the Provider Network Specialists, Provider Network Supervisor and Configuration Analysts.

Travel: Periodic travel, 10-20%, depending on business needs.

Knowledge, Skills and Abilities:

Combination of at least 10 years of Medicare/Medicaid and Managed Long Term Care experience in leadership rol.

MBA or equivalent business experience preferred

Strong background in operations, financial management, IT and accounting

Strong people skills and experience supporting a Director

Outstanding, leadership, management and organizational skills

Capacity to oversee a complex operation, and the leadership skills to function as a mentor and coach and filter/illuminate items requiring Director’s attention

Ability to budget and forecast demand, revenues and expenses and control costs./minimize overtime

Understand how to use data to drive & develop business plans and evaluate business trends to modify strategies and corrective actions

Ability to set and meet high standards of service to develop a work force that embraces a culture of quality and service

Ability to function effectively, exert influence and gain consensus at all organizational levels, in both direct, matrix and consultative organizational relationships, with internal stakeholders as well as external constituents

Personal integrity and exemplary ethical standards

Excellent time management skills and know how and when to impose deadlines and delegate tasks

Creative, innovative, and entrepreneurial with good business acumen

Tolerance for and the ability to perform in stressful and ambiguous situations

The ability to interpret and administer policies and procedures consistently and objectively

Outstanding communication skills with clarity of thought and the ability to express, advocate and defend views effectively both orally and in writing

The flexibility and the ability to work in a relatively unstructured environment in an evolving, growing and dynamic company

A forward-thinking personality who can identify areas for improvement and take decisive and timely action to bring about the desired change

The ability to attract, train, manage and motivate a skilled team

Physical Demands & Requirements :

Communicate by way of the telephone with participants, customers, vendors and staff

Operate a computer and other office productivity machinery, such as a calculator, copy machine, fax machine and office printer

Remain stationary for extended periods of time

Occasionally exert up to 20 pounds of force to lift, carry, push, pull or move objects

Visual acuity to perform activities such as identifying, inputting and analyzing data on a computer terminal and/or in hard copy

Occasional reaching to retrieve shelved items

Occasional bending/stooping

This job operates in a professional or home office environment with a conversational noise level.

No substantial exposure to adverse environmental conditions is expected

Moderate pressure to meet scheduled appointments and deadlines

Potential for occasional verbal aggression by clients and vendors

The Company is proud to be an equal opportunity employer. All qualified applicants will receive consideration without regard to ancestry or national origin, race or color, religion or creed, age, disability, AIDS/HIV, gender, marital or family status, pregnancy, childbirth or related medical conditions, genetic information, military service, protected caregiver obligations, sexual orientation, protected financial status or other classification protected by applicable law.

Keywords: The ABA Rule of Law Initiative, St. Louis , Assistant Director, Configuration & Provider Network Services, Other , Saint Louis, Missouri