Posted:6 days ago|
Platform:
Work from Office
Full Time
Position Overview: MDI NetworX is seeking a Deputy Manager / Manager Payer Operations to oversee end-to-end healthcare payer processes, drive operational excellence, and ensure compliance with US healthcare standards. This leadership role requires expertise in process optimization, stakeholder management, and team development Key Responsibilities: Lead and manage payer operations, ensuring efficiency and quality in service delivery. Develop and implement strategies to optimize claims processing, enrollment, and provider data management. Drive team performance, coaching, and professional development initiatives. Conduct salary negotiations and oversee talent acquisition for the department. Ensure compliance with HIPAA, ACA, and other payer regulations. Manage escalations, resolve critical process issues, and implement continuous improvement initiatives. Collaborate with senior leadership, clients, and cross-functional teams to enhance operational effectiveness. Monitor key performance indicators (KPIs) and generate actionable reports. Required Skills & Qualifications: Bachelors degree or equivalent experience. 8-12 years of experience in US healthcare payer operations. Strong expertise in claims adjudication, enrollment, and provider data management. Proven experience in leadership, stakeholder management, and process optimization. Proficiency in MS Office, healthcare payer systems, and data analytics. Excellent strategic thinking, communication, and problem-solving skills. Preferred Qualifications: Experience with Medicare, Medicaid, and commercial payer processes. Knowledge of EDI transactions (837, 835, 834). Prior experience in a BPO or shared services environment
Mdi Networx
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