Minimum of five (5) years of experience at a director or equivalent level with a strong knowledge of medical claims processing, healthcare delivery systems or statistics
Bachelor’s degree in Information Systems Technology, Computer Science, Healthcare, Business Administration or related field
Master’s degree is preferred
445 Grant Avenue, San Francisco, CA 94108
The Director of Information Systems Administration, and Informatics is accountable for overseeing IT Systems and Claims operations, including all health plan IT systems and business applications, maintaining integrity of provider and clinical data integrity in operating and analytical systems, customer and group implementations, monitoring of Electronic Data Interfaces (EDI), appeal processes, be responsible managing and developing standard operating procedures to ensure claims are processed accurately and timely. Ensures continuity and alignment of the Information Technology Department strategic and operational plans.
ESSENTIAL DUTIES AND RESPONSIBILITIES
- Provide strategic direction to claims department to ensure accurate and timely payment of claims. May personally handle settlement of certain large, sensitive claims. Approve all responses to state insurance department inquiries, which are prepared by subordinates.
- Direct claims administration through the implementation of policies, procedures and methods to perform claims investigating/processing efficiently and effectively in accordance with professional standards.
- Serve as a consultant to other areas of company and senior management regarding claims administration.
- Applies continuous quality improvement principles to the entire information system environment and to provide support to other department needs for analytic insights
- Maintain a positive relationship with internal and external customers, including other business units, to ensure accurate administration of life claims. May serve as company representative at industry meetings.
- Accountable for developing, implementing and monitoring the IT strategic plan
- Key contributor to the implementation of new products or business processes.
- Acts as primary liaison and manages relationships with outside vendors or agencies to execute CCHP IT programs (e.g. system implementations, upgrades) to expected levels or service according to agreed upon standards.
- Serves as Security Officer for CCHP.
- Develops, trains and mentors CCHP staff in regards to ensure compliance with externally committed service level standards.
- Regularly performs assessments not limited to IT capacity, usage, adoption, security and compatibility and develops plans to improve results across the users in CCHP.
- Key facilitator in developing/revising and managing compliance to company policies and procedures.
- Manages allocated department staff and budget
- Accepts and performs other duties as assigned.
- Bachelor’s degree in Information Systems Technology, Computer Science, Healthcare, Business Administration or related field. Master’s degree is preferred
- Minimum of five (5) years of experience at a director or equivalent level with a strong knowledge of medical claims processing, healthcare delivery systems or statistics.
- Experience in managing operations staff, establishing standard operating procedures, workflows to drive efficiencies, and establishing and measuring quality assurance standards.
- Three years of vendor management experience including contract negotiation, SLA development, performance monitory and budgetary maintenance.
- Vast knowledge of health plan claims repricing.
- Strong understanding of State/Federal laws and other regulatory agency requirements that relate to the medical, mental health and health insurance industry or Medicaid/Medicare industry
- Excellent analytic, problem solving, project management and organizational skills.
- Must demonstrate professionalism, good judgment and tact when dealing with sensitive and confidential issues.
- Proven history of achieving or exceeding organizational IT/IS goals
- Excellent verbal and written communication skills, including the ability to effectively communicate with internal and external customers.
- Excellent computer proficiency in MS Office products including expertise in MS Excel (creating spreadsheets and using advanced formulas) and PowerPoint.
- Ability to be a positive and influential role model for other department members
- Ability to assess training needs and may organize and conduct training sessions
- Maintains a positive attitude and provides exemplary customer service.
- Able to lift up to 30 pounds
- Use proper body mechanics when handling equipment
- Standing, walking and moving 50% of the day.
In our efforts to control the spread of COVID-19 and its variants, CCHP requires that its employees be fully vaccinated as of their start date. If you require a medical or religious accommodation we will engage in the interactive process with you. Proof of vaccination will be required prior to start. If we make you an offer and you are not yet vaccinated, we will accommodate a delay in start date. CCHP may also mandate that its employees receive vaccine boosters, and all accommodation laws will be followed.