HealthTrust - Employment
Director of Risk Pool Operations
DIRECTOR OF RISK POOL OPERATIONS
HealthTrust seeks a highly responsible professional providing vision and leadership in managing all facets of Risk Pool Operations including but not limited to vendor management, enrollment, member retention and growth, Well-Being programs and services, and all benefit and marketing materials, as well as website and portal content and functionality. This includes account management functions, contact center management, design and management of HealthTrust’s benefit portfolio, day-to-day management of vendor contracts and service levels, and budget development and monitoring for Risk Pool Operations and Well-Being programs.
Work encompasses responsibility for selecting and managing consultants and contracted service providers; strategic planning and implementation; developing and implementing new programs, procedures, and special projects; overseeing all aspects of Member services.
Further this position focuses on identifying and establishing strategic marketing and branding strategies that enhance Member Groups’ understanding and support of all the products and services offered by HealthTrust and coordinating the creation of informational material for all related programs and services. This position incorporates, solidifies and leverages the brand image of HealthTrust in internal and external communications. Additionally, this position has ultimate responsibility for the external public website and the Secure Member Portal (SMP), Secure Enrollee Portal (SEP) and Wellness Coordinator Portal (WCP). The position is responsible for executing the Member Group retention and recruitment strategy, which includes both marketing and service elements.
The employee is responsible for keeping the Executive Director and governing body fully informed any issues that may adversely impact the service levels provided to Member Groups or Covered Individuals and any contractual items that impact the ability to hold vendors accountable for the products or services provided to HealthTrust.
The employee has direct supervisory authority over the Risk Pool Operations Unit and interacts professionally with other HealthTrust staff, and the Board, and a wide variety of external contacts. A high degree of independence, initiative, and follow-through is expected.
1. As an active Leadership Team member, takes a leadership role in the organization and participates in HealthTrust leadership and management activities, including participation in Leadership Team meetings, attendance at HealthTrust Board and committee meetings, and strategic planning for the organization. In collaboration with the Leadership Team, helps to foster a positive, success-oriented, accountable culture within the organization. Keeps HealthTrust Executive Director informed about Unit activities, issues, problems and opportunities.
2. Responsible for the day-to-day operational effectiveness of the Risk Pool Operations Unit. Initiates, develops, coordinates, and implements operating procedures and standards for administering existing and new programs; supervises and evaluates tests of these procedures and standards to ensure that the desired objective is achieved. Develops and maintains up-to-date operational manuals for the Risk Pool Operations Unit and ensures their application in daily operations. Reviews, develops and implements (as applicable) services and tools to improve productivity, workflow and service to Member Groups and Covered Individuals.
3. Leads, manages, and coordinates the work of the Risk Pool Operations Unit. Maintains a climate which attracts, retains, and motivates a diverse staff of top quality individuals. This position is responsible for overall management of the Unit staff including monitoring and prioritizing of work flow to ensure timeliness, responsiveness, and quality of both routine tasks and strategic initiatives. Identifies cross-training opportunities to ensure the Unit is fully cross-trained in order to handle any fluctuations in workload levels or available resources. Coordinates training of new and existing staff on established policies and procedures. Evaluates employee work performance and initiates appropriate mentoring, counseling and disciplinary actions where warranted. Prepares and delivers annual evaluations of staff including setting annual goals.
4. Assists Risk Pool Operations Unit and other HealthTrust staff, as well as Covered Individuals, Member Groups, consultants, providers, and vendors by answering questions and troubleshooting problems. Resolves special problem issues, especially those pertaining to enrollment and eligibility of HealthTrust Member Groups and Covered Individuals related to HealthTrust’s products, services and programs; consults with Leadership Team members and/or Executive Director as warranted.
5. Develops and implements benefit program and other related services enhancements to meet the needs of Member Groups and Covered Individuals. Collaborates with other departments in new product development and consolidation or elimination of existing products, services and/or programs. Leads efforts on product development and understanding of competitive products and strategies to promote future offerings and expand membership. Implements business retention strategies. Works to identify strategies to increase retention and satisfaction of Member Groups and Covered Individuals. Primarily responsible for the planning, program development and implementation of HealthTrust’s public events, in collaboration with HealthTrust’s subject matter experts who provide and oversee the content for such events, including without limitation the HealthTrust Summit, Rate Hearings, and the Annual Member Meeting.
6. Works closely with the Technology Services Unit to develop new functionality, identify system issues and provide support in troubleshooting problems, prioritizing requests, implementing system or process efficiencies, etc. Responsible for ensuring proper end-user testing is completed prior to release of new or enhanced functionality. Understands electronic data interchange (EDI) enrollment methods. This includes primary ownership of the functionality and the ongoing strategic planning relative to the Enrollment, Billing and Claims software utilized by HealthTrust as well as the Secure Member Portal (SMP).
7. Manages and coordinates contracted services from medical, pharmacy, dental, Life/LTD, Well-Being program vendors and associated consultants. Manages RFP process for all of the Risk Pool operations contracted benefits and services. Develops and maintains mutually beneficial relationships with vendors and resolves service issues. Negotiates contract terms, conditions and fees and evaluates performance in collaboration with Executive Director, General Counsel and other applicable Leadership Team members.
8. Ensures in conjunction with Benefit & Coverage Counsel HealthTrust compliance with federal laws such as COBRA, HIPAA, Medicare Secondary Payer, and ACA, including updating documents and notifying Member Groups and Enrollees as required. Ensures compliance with applicable state laws as well. Maintains vendors’ compliance with new rules and regulations. Ensures HealthTrust’s coverage documents for medical, dental, life, STD, LTD, FSA and HRA are kept up-to-date and distributed appropriately.
9. Oversees the development of plan documents, forms, operational documents, publications, and other materials for use by and distribution to HealthTrust Member Groups and Covered Individuals in securing and understanding the employee benefits products, services and programs, and HealthTrust operations in conjunction with the Engagement Department. Ensures that HealthTrust Member Groups and Covered Individuals are provided with timely notice of changes in coverage, procedures, benefit options, and policies. Writes articles or other material regarding HealthTrust operations for distribution to HealthTrust Member Groups and Covered Individuals.
10. Participates in the development of all employee benefit rates and contributions from HealthTrust Member Groups. Provides input on potential Member Group and Covered Individual ramifications, impact of any RFP or contract renewals and provides information relative to any market place trends that could impact the work of the actuaries. Responsible for drafting the updated rate package materials for each renewal, including cover letter. Ensures rate packages and analysis are available in a timely manner to respond to Member Group questions. Oversees proposal process managed by the Benefit Services Department and provides final approval of proposals prior to release, once rates are approved by the Executive Director. Participates in process, as needed by collaborating with HealthTrust Member Groups, consultants and brokers to address questions, concerns and provide information about HealthTrust services and programs. Assists staff and Member Groups with coverage analysis and comparisons to understand alternative proposals. Works with staff, consultant and/or Member Group to enhance understanding of bid process. Reviews proposal packages including rates, options, and associated material.
11. Performs other duties as required.
Bachelor’s degree required, preferably in health care administration, business, or public administration, or a closely related field. Master’s degree in Business Administration or related field, or other evidence of substantial business knowledge, is desirable. At least eight years of relevant work experience in a responsible management position with an operations, customer service, and account management focus. Technical familiarity with enrollment, billing and claims applications as well as the use of multiple databases, spreadsheets, and computer based records maintenance systems highly desired.
In lieu of the above, any equivalent combination of training and experience that provides the above referenced knowledge, abilities, and skills may be considered at the discretion of HealthTrust.
In addition to competitive salaries, HealthTrust provides a family-friendly work environment and offers excellent benefits including health, dental, life insurance, short-term and long-term disability insurance, a defined benefit pension plan and a deferred compensation plan, flexible spending accounts, and an on-site fitness center.
HealthTrust is committed to the principle of equal employment opportunity for all employees and to providing employees with a work environment free of discrimination and harassment. All employment decisions at HealthTrust are based on business needs, job requirements and individual qualifications, without regard to race, color, religion, age, sex, national or ethnic origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws. This policy applies to all terms and conditions of employment, including recruiting, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absence, compensation and training.
Salary: $125,250.00 - 162,850.00
