Director - Carrier Revenue Operations

2 days ago

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Progyny, Inc.

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healthcare • medical • financing • fertility • egg freezing

201 - 500

Description

• Oversee Carrier Revenue Operations team and aspects of revenue claims management • Negotiate agreements with carriers, securing favorable terms and conditions • Monitor and evaluate carrier performance through metrics and reports, addressing any issues or opportunities for improvement • Collaborate with Implementation to ensure seamless integration and delivery of health insurance products and services • Analyze market trends and industry developments to identify potential carrier partnerships and enhance service offerings • Ensure compliance with regulatory requirements and company policies related to health insurance and carrier operations • Manage the implementation of new insurance products and services, coordinating with carriers to ensure smooth execution • Lead, mentor, and develop a team of carrier management professionals, fostering a culture of collaboration and excellence • Prepare and present reports on carrier performance, team performance, and other key metrics to senior management • Address and resolve any escalated issues or disputes with carriers in a timely and effective manner • Identify trends in claims denials, reimbursements and payment discrepancies and implement solutions to facilitate successful claims processing • Analyze large sets of data to identify trends, patterns, and insights • Utilize statistical methods and software tools to support data-driven decision-making • Lead executive reporting on claims processing, denials, cash flow, and various special projects • Anticipate & identify risks, drive the development and monitor the implementation of comprehensive mitigation strategies; coordinate financial operations responses to regulatory/client external audit requests

Requirements

• 10+ years of experience in health care claims processing/accounting/finance operations • Bachelor’s degree required • Extensive experience in health insurance or carrier management roles, with a significant portion in a leadership capacity • In-depth knowledge of the health insurance industry, including regulatory requirements, carrier operations, and market trends • Experience managing a large team • Ability to tap into a wealth of knowledge and experience to solve problems and act as an internal consultant • Ability to effectively synthesize problems and implement solutions in a fast-paced environment • Strong experience in excel and comfortable working with large data sets to analyze and reconcile data • Excellent communication ability, able to partner with internal stakeholders, including senior leadership • Ability to present findings to executive leadership in a clear and concise manner

Benefits

• Paid family and parental leave • fertility and family building benefits (including egg freezing, IVF, and adoption support) • family care fund and Parents’ Employee Resource Group • Health, dental, vision and life insurance options for employees and family • Free in-person, virtual and text-based mental health and wellness support • Paid time off, including vacation, sick leave, personal days and summer flex time • Company equity • Bonus program • 401(k) plan with company match • Access to on-demand legal and financial advice • Company social events • Flex days (3 days a week in the office) and onsite meals and snacks for employees reporting into our NY office