Director of Claims Operations / 115

Occupation:General/Other: Production/Operations Position Description:This position functions with full principal for Viant Claims Operations (including Repricing, Negotiations, Medicare, and Bill Review Services). This position requires excellent personnel management skills, an intense technical knowledge of PPO, HMO, and IPA network provider data, contract interpretation, claim administration, workflow management, customer service and client interface, and Total Quality Management. Excellent skills in communication, relationship management, and employee motivation are required in this position. This position is responsible for operations and staff at multiple locations.JOB RESPONSIBILITIES: Duties and responsibilities include:' Establishes and oversees overall daily and strategic operation for Viant Claims Operations' Establishes and implements Policy & Procedures for Viant Claims Operations' Establishes and implements process and procedure workflows and identifying efficiencies and cost savings to support Claims Revenue Optimization' Establishes and administers training programs, manuals, and job aids in support of Viant eSuite applications for external clients as well as all departments within Viant Health Payment Solutions' Designs and oversees UAT for implementation of all new systems, system upgrades, conversions and integrations necessary to support Viant Claims Operation' Responsible for all client and new product implements impacting Viant Claims Operation' Develops and oversees Total Quality Management across all departmental areas that impact or interact with Viant Claims Operation, including but not limited to Provider Data Management, Reimbursement, Negotiations, and Bill Review functions' Sets audit and security protocol and documents same for internal and external audit purposes' Supports external, client and third party claim audits including SOX and SAS 70 audits' Manages Client Appeals and Disputes and completes root cause analysis of patterns and trends to implement changes in Policy, Concurrent Audits, and training needs' Coordinates synergies to ensure all are well versed in company knowledge, position expectations and complete client satisfaction' Coordinates or participates in meetings with Sales, Acct Managers, Customer Champions, Client Implementation and other divisions of the company to discuss client specific initiatives and prepare for new business and products' Collaborates with Account Management, Customer Champions, Customer Service and department managers as it relates to handling special projects, service implementations and work flow efficiencies' Constantly ensure that we are meeting the clients and Operations expectations by delivering complete, accurate and prompt resolution of issues' Manage department projects and other projects as assigned by the department head that are affiliated with company wide initiatives' Travel as needed to other Viant offices for purpose of automation, centralization and identifying efficiencies' Develops and generates statistical reporting such as tracking for performance, client issues on a weekly/monthly or as needed basis Qualifications:EDUCATION/CREDENTIALS:' Bachelor's Degree requiredJOB RELEVANT EXPERIENCE:' 10 years experience, preferably in an insurance /healthcare environment' 10 years of managerial backgroundJOB-RELATED SKILLS/COMPETENCIES:' Excellent organizational skills' Must be able to communicate effectively across multiple levels of ' Knowledge of the principals of TQM / CQI' Six Sigma certification preferred' Must have at least ten years experience in claims and PPO network provider data management.' Must have at least ten years experience in personnel management' Bachelor's degree required' Must be able to motivate the staff' Ability to travel' Technical skills with computer systems' Demonstrated skills in workflow management and design' Demonstrated commitment to the principles of diversity Location: Naperville, IL 60563 Job Status/Type: Full Time, Employee Career Level: Manager (Manager/Supervisor of Staff) Job RefCode: 115