The Aspen Group (TAG) is one of the largest and most trusted retail healthcare business support organizations in the U.S. and has supported over 20,000 healthcare professionals and team members with close to 1,500 health and wellness offices across 48 states in four distinct categories: dental care, urgent care, medical aesthetics, and animal health. Working in partnership with independent practice owners and clinicians, the team is united by a single purpose: to prove that healthcare can be better and smarter for everyone. TAG provides a comprehensive suite of centralized business support services that power the impact of five consumer-facing businesses: Aspen Dental, ClearChoice Dental Implant Centers, WellNow Urgent Care, Chapter Aesthetic Studio, and AZPetVet. Each brand has access to a deep community of experts, tools and resources to grow their practices, and an unwavering commitment to delivering high-quality consumer healthcare experiences at scale.
As a reflection of our current needs and planned growth we are very pleased to offer a new opportunity to join our dedicated team as the Director Regional Operations + Process Assurance.
The Director of Regional Operations and Process Assurance plays a vital role within our Payor Strategy Team. The successful candidate will report to the Vice President, Payor Strategy, and oversees a team of 3 - 5 individuals with a focused support on regional operations for Aspen Dental, including the management of local plan relationships. This role owns the process assurance function for the department, running proactive audits and managing the standard operating procedures and processes that keep the team's work accurate and roles clear.
Essential Functions
- Develops and maintains effective working relationships with insurance company contacts for assigned regional plans.
- Oversee the entire operational relationship with assigned regional plans, including grievances, rate validation, educational outreach, and any other operational issue that affects the plan.
- Proactively looks for ways to improve support to Aspen offices, streamline processes with plans, and increase transparency and issue resolution for offices and owners.
- Oversee and participate in Joint Operating Committees (JOCs) for assigned regional plans, driving continued results with plan partners.
- Owns and maintains data sources to ensure network and contract processes remain accurate.
- Manages and updates standard operating procedures.
- Proactively audits data monthly to confirm accurate network information and quickly resolve contract data issues.
- Identifies trends across markets and partners with department heads to build educational resources for the plans.
- Oversee the distribution of field education and company initiatives to the field as needed.
- Acts as an expert resource on escalated contractual and compliance issues within the region.
- Monitors contract performance and other provisions to assure compliance, identify problem areas, and resolve disputes.
- Resolves escalated contract issues generated by operational department heads.
- Other duties as assigned.
Team Management
- Train, support, and develop the team to meet department metrics and expectations.
- Ensure the team delivers first class customer service to owners.
- Efficiently resolves plan related issues raised by owners and the field.
- Creates education and resources for the field so they have what they need.
- Coaches the team on grievance handling and root cause identification to prevent repeat issues.
Experience
- Bachelor's degree
- Highly proactive, with strong critical thinking skills and the ability to architect solutions rather than just flag problems
- Direct experience with insurance and provider contracting required. Must have been personally involved in managed care contracting or contract strategy work, not just adjacent to it
- Strong exposure to healthcare operations required. Dental experience is not required; medical or other clinical operations experience is a fit
- 7 or more years of progressively responsible management or supervisory level managed care contracting or provider network operations experience in a payor or health care setting, including experience leading audit, quality assurance, or process improvement functions
- Broad knowledge of healthcare insurance, healthcare billing and reimbursement, administration, systems, practices and principles (i.e. Medicare, Medicare Advantage, and Commercial)
- Experience building and enforcing standard operating procedures and audit processes
- Excellent verbal and written communication
- Excellent time management, prioritization, and organizational skills
- Detail oriented with a strong level of analytical and problem-solving skills
- Proficient use of Microsoft Office Suite
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- Salary: Annual pay range: $160,000 - $175,000, plus bonus/incentives
- A generous benefits package that includes paid time off, health, dental, vision, and 401(k) savings plan with match
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