SVP,Operations

Position Summary:

To direct, empower, and lead operational departments such as Claims, Customer Service, Human resources and Facilities/Mailroom in meeting all of the objectives and compliance goals. To maintain in strict confidence, all MRG/HPN, member, provider and Health Plan information to which Vice President of Operations has access.

Essential Duties and Responsibilities include the following:

• Coordinate the development of, and oversee the execution of Claims, Customer Service, Human Resources and Facility/Mailroom operations to ensure adherence to all contractual and regulatory requirements.

• Perform the administrative functions such as departmental budgets, financial planning and staff projections.

• Oversee the training and resource material as needed.

• Oversee the development of Policy and Procedures for Department as needed.

• Support company activities such as company goals/strategy and management meetings as required.

• Interpret the contracts and claims for the appropriate payment and benefit determination.

• Create and run reports for department oversight, and compliance issues.

• Represent the Claims Department in Operation, Committee and health plan Meetings.

• Oversee the Health Plan and regulatory audits, and represent Claims in all audit processes.

• Keep senior executive staff informed of operational activities.

• Develop reports for internal and external reporting needs.

• Responsible for meeting or exceeding established departmental goals such as production standards, compliance, and claims accuracy.

• Evaluate staff as part of interview or review process and make recommendations for employee hiring, firing, and/or retention.

• All other duties as assigned by management.

The pay range for this position at commencement of employment is expected to be between $250,000 and $300,000 year; however, base pay offered may vary depending on multiple individualized factors, including market location, job-related knowledge, licensure, skills, and experience.

The total compensation package for this position may also include other elements, including a sign-on bonus and discretionary awards in addition to a full range of medical, financial, and/or other benefits (including 401(k) eligibility and various paid time off benefits, such as vacation, sick time, and parental leave), dependent on the position offered.

Details of participation in these benefit plans will be provided if an employee receives an offer of employment.

If hired, employee will be in an “at-will position” and the Company reserves the right to modify base salary (as well as any other discretionary payment or compensation program) at any time, including for reasons related to individual performance, Company or individual department/team performance, and market factors.

As one of the fastest growing Independent Physician Associations in Southern California, Regal Medical Group, Lakeside Community Healthcare & Affiliated Doctors of Orange County, offers a fast-paced, exciting, welcoming and supportive work environment. Opportunities abound, and enterprising, capable, focused people prosper with us. We promote teamwork, nurture learning, and encourage advancement for all of our employees. We want to see you excel, because we believe that your success is our success.

Full Time Position Benefits:

The success of any company depends on its employees. For us, employee satisfaction is crucial not only to the well-being of our organization, but also to the health and wellness of our members. As such, we are firmly dedicated to providing our employees the options and resources necessary for building security and maintaining a healthy balance between work and life.

Our dedication to our staff is evident in our comprehensive benefits package. We offer a very generous mixture of benefits, including many employer-paid options.

Health and Wellness:

• Employer-paid comprehensive medical, pharmacy, and dental for employees
• Vision insurance
• Zero co-payments for employed physician office visits
• Flexible Spending Account (FSA)
• Employer-Paid Life Insurance
• Employee Assistance Program (EAP)
• Behavioral Health Services

Savings and Retirement:

• 401k Retirement Savings Plan
• Income Protection Insurance

Other Benefits:

• Vacation Time
• Company celebrations
• Employee Assistance Program
• Employee Referral Bonus
• Tuition Reimbursement
• License Renewal CEU Cost Reimbursement Program
• Business-casual working environment
• Sick days
• Paid holidays
• Mileage

Employer will consider for employment qualified applicants with criminal histories in a manner consistent with the requirements of the LA City Fair Chance Initiative for Hiring Ordinance.

Education and/or Experience:

• Extensive experience in managing large claims staff, with multiple health plans, products and regions.

• Excellent professional and hospital claims adjudication skills.

• Full working knowledge of TPL, COB, PPO, POS, HMO, ASO and Indemnity products.

• Knowledge of DRG Grouper.

• Knowledge of CPT-4, HCPCS, Revenue and ICD-9 coding.

• Extensive knowledge of Medicare, and Medi-Cal.

• Knowledge of contracts and contractual interpretations for payment and benefit issues.

• Strong knowledge of Microsoft Windows environment.

• Working knowledge of Microsoft Excel and Word.

• Excellent written and verbal communication skills.

• Strong organizational and leadership skills.

• Experience developing and producing management reports.

• EZ-Cap experience helpful.