AVP, Out of Network Solutions

Claritev Corporation; Remote; USD 160,000 - 175,000; Full time

Job summary

A leading healthcare company is seeking an AVP, Medical Reimbursement Analysis to lead and coordinate the MRA department, ensuring operational efficiency and client satisfaction. The ideal candidate will have over 10 years of experience in operational management, with strong leadership and analytical skills. This full-time, executive-level role offers competitive salary and benefits including health insurance and bonus opportunities.

Benefits

Health insurance

401(k)

Bonus opportunities

Qualifications

• Minimum 10 years of experience in operational management, including 7 years in healthcare.
• Strong leadership, analytical, organization, and prioritization skills.
• Ability to manage multiple tasks and adapt to changing priorities.

Responsibilities

• Direct daily operations to ensure quality results and operational efficiency.
• Establish performance standards and strategic planning for the department.
• Collaborate and communicate across departments for achievement of goals.

Skills

Operational management

Healthcare market knowledge

Leadership skills

Analytical abilities

Communication skills

Education

Bachelor's degree in a relevant field

Tools

MS Office

Job description

Overview

AVP, Medical Reimbursement Analysis (OON) (Remote)

Pay information and base pay range are provided in the post.

Salary and Benefits

Base pay range: $160,000.00/yr - $175,000.00/yr

The position is eligible for health insurance, 401(k) and bonus opportunities. Benefits details are provided in the job description.

Job Summary

This position leads, plans, develops and directs all aspects of the Medical Reimbursement Analysis (MRA) department. The role partners with senior management to define and execute short- and long-term business goals to grow the business and ensure operating efficiencies.

Responsibilities

• Direct the daily operations of assigned business units to ensure consistent delivery of quality results, operational efficiency and achievement of client expectations. Perform analyses to drive problem solving and innovation in processes, including business process re-engineering, automated solutions and overall product and service excellence.
• Provide leadership for multiple sites across the department with real-time management and forecasting. Support succession planning and business strategy.
• Establish and maintain departmental performance standards and strategic planning to support compliance, service and savings, maximizing opportunities to strengthen the customer experience.
• Manage execution of the MRA (DIS) Services objectives through team members in a timely, cost-effective manner.
• Develop and maintain strong relationships internally and externally, ensuring open communication across departments to meet company and department goals.
• Develop and maintain action plans and processes to monitor and improve retained savings based on client requirements.
• Oversee execution and resolution of complex service and claims issues in a timely and effective manner with minimal supervision.
• Direct budget process and financial planning for assigned cost centers, balancing cost containment with department needs and customer satisfaction.
• Serve as business sponsor for Agile application development projects and related client implementation initiatives to drive performance, processes and quality.
• Engage in ongoing dialogue with sales, account management and regulatory teams in support of the product portfolio.
• Select, develop, and evaluate staff to ensure efficient department operation.
• Collaborate, coordinate and communicate across disciplines and departments.
• Ensure compliance with HIPAA regulations and requirements.
• Demonstrate the Company\'s core competencies and values.
• Note: this role involves exposure to PHI and is considered a High-Risk role.

Job Scope

This is a key leadership role with ownership over product performance, requiring strong communication and coordination of client requests to achieve business goals. The incumbent works independently under minimal supervision, making decisions that affect day-to-day operations. This is a people management role with authority for hiring, discipline, performance management, coaching and mentoring.

Job Requirements (Education, Experience, and Training)

• Minimum bachelor\'s degree in a relevant field with 10 years of experience in an operational management/leadership role, including at least 7 years in healthcare markets (e.g., insurance companies, TPA, HMO, or managed care).
• Required licensures, professional certifications, and/or Board certifications as applicable.
• Knowledge of health care and managed care products.
• Strong communication, leadership, planning, interpersonal, analytical, negotiation, organization, and prioritization skills.
• Ability to elicit trust and credibility and interface with all levels of the organization; ability to build relationships with internal and external customers.
• Ability to formulate solutions and involve others in solving issues; comfortable with in-person client interface.
• Commitment to high standards of quality and integrity; ability to travel as needed.
• Proficiency with MS Office and related hardware/software; ability to lead and mentor individuals and teams; professional representation of the company.
• Ability to manage multiple tasks and adapt to changing priorities; maintain collaboration with counterparts for operational support and strategic planning.
• Eligible to work in a standard office environment (sitting and using monitor(s) for extended periods).

Application Deadline

We will generally accept applications for at least 5 calendar days from the posting date or as long as the job remains posted.

Seniority level

• Executive

Employment type

• Full-time

Job function

• Finance
• Sales

Industries

• Hospitals and Health Care

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