Manager Dental Government Business Operations

Description

JOB SUMMARY

Due to Department of Defense (DOD) contract requirements, the incumbent who fills this position must be a US citizen and must also pass a background check.

This job is responsible for managing the contracts that support the dental government business, as well as the staff that support the contracts.

Responsibilities include managing daily operational activities for enrollment and billing, claims, including foreign claims, and customer service telephone, written and appeals.

Employees are cross-trained to support multiple contracts. Position serves as a government point of contact for enrollment and premium reconciliation, overseas provider network issues and support, and for operational issues and audits.

Assists in the development of the budget for each contract.

ESSENTIAL RESPONSIBILITIES

• Performs management responsibilities to include, but are not limited to : involved in hiring and termination decisions, coaching and development, rewards and recognition, performance management and staff productivity.
• Plans, organizes, staffs, directs and controls the day-to-day operations of the department; develops and implements policies and programs as necessary;

oversees accuracy of internal and government reporting data, assists with budget development and tracks monthly expenses to ensure budget compliance.

• Provides management oversight of the day-to-day activities related to enrollment and monthly premium billing issuance and reconciliations with the government.
• Develops plans of action and provides manager support to utilize effectively workforce management tools and reports to ensure all timeliness and accuracy requirements are met for enrollment / billing, claims customer service telephone and written / appeals are met for all contracts (TDP, ADDP, and FHFA).
• Functions as a government point of contact for enrollment and premiums reconciliation, oversees provider network issues / support, for operational claims or customer service issues and for government audits.
• Oversees the daily activity for foreign claims processing and customer service, which requires foreign translations of claims, narrative and other documents, and foreign current conversions for oversees provider payments.
• Oversees the training program to ensure that training course content is complete, current, and meets the initial and ongoing cross-training instruction needed to service multiple contracts with competency and accuracy.
• Functions as the department representative for meetings related to system changes that impact operations.
• Other duties as assigned or requested.

REQUIRED EDUCATION

High School Diploma / GED

No Substitutions

PREFERRED EDUCATION

Bachelor’s Degree - Business, Healthcare or other related area.

EXPERIENCE

Due to Department of Defense (DOD) contract requirements, the incumbent who fills this position must be a US citizen and must also pass a background check.

• 3 - 5 years' experience functioning as a supervisory, or lead role responsible for assisting with employee development and / or oversight, preferably in a claims or customer service production environment
• Knowledge of government contract reporting and performance requirements, standards, policies and procedures
• Experience supervising or managing multiple processing functions, including enrollment and billing, claims / adjustments, and customer service telephone / IVR, and written / Internet correspondence (routine, priority and appeals)
• Experience in developing and executing effective policies, procedures and performance action plans to ensure that performance standards and corporate goals are consistently met
• Experience functioning as a lead and / or participant in the completion of projects
• Experience working in a production environment with diverse functions and multiple types of benefits and / or contracts
• Prior government business experience, preferably dental
• Knowledge of dental health policy applied to claims processing

KNOWLEDGE, SKILLS & ABILITIES (

• Strong personnel management and coaching / mentoring skills; able to build an environment and business culture of trust and respect, where employees are inspired to work together collaboratively and to the best of their ability to ensure contract and corporate goals are met
• Strong leadership and visionary skills to develop effective plans of action to ensure that all reporting and operational requirements are consistently met for multiple contracts
• Excellent listening, verbal and written communication skills; able to draft policies and procedures, develop management reports, and provide presentations and / or lead meetings for management and department personnel
• Strong knowledge in contract requirements and dental systems and website applications, including enrollment and billing, claims / adjustments, and customer service telephone / IVR, and written / Internet correspondence (routine, priority and appeals)
• Strong collaboration and teamwork skills; able to attain consensus and effectively work to resolve problems and / or conflict
• Employees supporting the TDP and / or ADDP contract must complete a Government background questionnaire and verification process and attain a favorable trustworthiness determination as required by the Department of Defense (DoD) contract.

In addition, the DoD requires incumbents to be citizens of the United States of America

Position requires flexibility to work periodically in the evening to interface and coach overnight shift employees, as well as provide direction and / or address issues if and when needed

PHYSICAL, MENTAL DEMANDS AND WORKING CONDITIONS

Office-Based

An employee in this position works in an office environment. The position frequently requires the employee to communicate effectively with others both inside and outside the workplace (e.

g., in person, via telephone, via email). The employee must be able to understand, interpret and analyze data, solve problems, concentrate, and research, use available technological resources and systems (e.

g., computers and computer programs), multi-task, prioritize, and meet multiple deadlines to complete essential tasks. The employee generally works in a fast-paced and frequently stressful environment, must attend work on a regular and reliable basis as well as adhere to all workplace policies, and may be called upon to work outside regular business hours.

Teaches / Trains others regularly Occasionally

Travels regularly from the office to various work sites or from site-to-site Rarely

Physical Work Site Required Yes

As a component of job responsibilities, employees may have access to covered information, cardholder data, or other confidential customer information that must be protected at all times.

In connection with this, all employees must comply with both the Health Insurance Portability Accountability Act of 1996 (HIPAA) as described in the Notice of Privacy Practices and Privacy Policies and Procedures as well as all data security guidelines established within the Company’s Handbook of Privacy Policies and Practices and Information Security Policy.

Furthermore, it is every employee’s responsibility to comply with the company’s Code of Business Conduct. This includes but is not limited to adherence to applicable federal and state laws, rules, and regulations as well as company policies and training requirements.

Pay Range Minimum : $67,500.00

$67,500.00

Pay Range Maximum : $124,800.00

$124,800.00

Highmark Health and its affiliates prohibit discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities, and prohibit discrimination against all individuals based on their race, color, age, religion, sex, national origin, sexual orientation / gender identity or any other category protected by applicable federal, state or local law.

Highmark Health and its affiliates take affirmative action to employ and advance in employment individuals without regard to race, color, age, religion, sex, national origin, sexual orientation / gender identity, protected veteran status or disability.

EEO is The Law

Equal Opportunity Employer Minorities / Women / Protected Veterans / Disabled / Sexual Orientation / Gender Identity ()

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