Director of Insurance Operations

About the Role:
The Director of Insurance Operations will own all elements of payer-facing operations including revenue cycle, payer contracting, and credentialing. This role is responsible for optimizing our fee-for-service collections, organizing and executing on our payer contracting priorities, and ensuring our providers are licensed and credentialed with key health plans. The Director will collaborate with internal stakeholders, including finance, clinical operations, and legal & compliance teams, to ensure payer contracts, collections and credentialing processes align with organizational goals.

What you'll do (Job Responsibilities):

- Strategic Planning:

• Review, refine, and implement a comprehensive strategy for Found’s initial and ongoing payer contracting approach.
• Review existing revenue cycle processes and recommend tools and processes to improve overall collection rates and time to collect.
• Collaborate with executive leadership to align the contracting strategy with overall organizational objectives and goals.

- Revenue Cycle Management (RCM) Support:

• Collaborate with the RCM team to ensure telehealth contracts support optimal revenue cycle performance.
• Provide guidance on billing and reimbursement issues related to telehealth services.
• Address and resolve payer-related issues impacting RCM functions.

- Provider Enrollment and Credentialing:

• Lead and manage provider enrollment and credentialing functions to ensure timely and accurate provider onboarding.
• Develop and implement processes to streamline and improve provider credentialing.
• Ensure compliance with all credentialing and enrollment regulations and standards.
• Oversee credentialing vendors and ensure their performance meets organizational standards.

- Market Analysis:

• Conduct market research and analysis to identify competitive trends and opportunities.
• Assess the financial impact of contracts and propose strategies to maximize revenue and reimbursement.
• Monitor and analyze changes in telehealth reimbursement policies and regulations.

- Contract Negotiation:

• Establish and maintain strong relationships with payer representatives to facilitate successful negotiations.
• Lead the negotiation of contracts with applicable commercial payers as defined by the over arching payer strategy.
• Ensure contracts are financially favorable and compliant with regulatory requirements.

- Stakeholder Collaboration:

• Work closely with internal teams, including finance, operations, legal, and clinical departments, to support fee for service initiatives.
• Provide guidance and support to operational teams to ensure the successful implementation of payer contracts.
• Communicate effectively with senior leadership and other key stakeholders to report on contracting activities and outcomes.

- Performance Management:

• Establish metrics and KPIs to evaluate the performance of insurance operations.
• Monitor performance and identify areas for improvement.
• Prepare and present regular reports on performance to senior leadership.

Experience:

• Bachelor’s degree in Business Administration, Healthcare Administration, Finance, or a related field required. Master’s degree desirable.
• Minimum of 7-10 years of experience in healthcare insurance operations, with a minimum 2-3 year focus in a startup healthcare environment.
• Proven track record of successful revenue cycle management and implementation.
• Experience in strategic planning and payer contracting.
• Experience managing provider enrollment and credentialing functions.

Skills:

• Strong understanding of insurance reimbursement models and revenue cycle fundamentals.
• Excellent communication skills.
• Ability to analyze complex data and make strategic decisions.
• Strong leadership and project management skills.
• Knowledge of healthcare regulations and compliance.
• Bias to action and get stuff done.