The Information Technology Director, Billing and Enrollment, is responsible for leading and delivering the IT initiatives related to the organization's member billing and enrollment systems. This role requires a deep understanding of healthcare payer operations, particularly in the areas of member enrollment, premium billing, and reconciliation processes. The Director will ensure that the billing and enrollment systems are efficient, accurate, and compliant with regulatory requirements. They will work closely with business stakeholders, enterprise architecture, product management, external partners, and IT executives to optimize processes, implement technology solutions, and drive continuous improvement.
Key Responsibilities:
Leadership and Strategy:
- Lead by example demonstrating and promoting Medica's Leadership Principles: Enterprise Mindset, Intense Curiosity, Critical Thinking, Accountability, and Collaboration.
- Develop and execute the IT strategy in partnership with product management, enterprise architecture, and business leadership for billing and enrollment, ensuring alignment with organizational goals and enterprise architecture vision and strategy.
- Lead a small team of managers and sr. managers and be collectively accountable for multiple IT scrum teams, fostering a culture of collaboration and innovation.
- In partnership with Product Management, collaborate with enrollment, billing, finance, and other departments to understand business needs and translate them into technology solutions.
- Financial management and forecasting at the cost center level.
Billing and enrollment Systems Management:
- Oversee the maintenance, enhancement, and support of billing and enrollment systems, ensuring they are reliable and meet business requirements.
- Lead the integration of new technologies to improve the efficiency and accuracy of billing and enrollment processes.
- Ensure systems are safe, stable, sustainable, and scalable to handle growth in membership and changes in billing models.
Healthcare Compliance and Data Security:
- Ensure that billing and enrollment systems comply with healthcare regulations, such as HIPAA and state-specific requirements.
- Ensure data security measures are implemented and enforced to protect sensitive information.
- Monitor and ensure data integrity, particularly in the areas of enrollment, premium billing, and financial reconciliation.
Process Improvement and Optimization:
- Lead efforts to streamline billing and enrollment processes through automation and system enhancements.
- Identify opportunities to improve the accuracy and timeliness of billing, reduce administrative costs, and enhance member satisfaction.
- Work with stakeholders to develop and implement best practices in billing and enrollment operations.
Program Management:
- Plan and oversee IT programs within an agile operating model related to billing and enrollment, ensuring they are delivered on time, within scope, and within budget.
- Coordinate with internal teams and external vendors to implement system upgrades, new functionalities, and integrations.
- Track and report on project progress, risks, and outcomes to executive leadership.
Vendor and Budget Management:
- Manage relationships with software vendors, consultants, and service providers related to billing and enrollment technologies.
- Commercial software analysis and selection.
- Develop and manage the budget for billing and enrollment IT initiatives, ensuring efficient use of resources.
- Evaluate and negotiate contracts with vendors to ensure the organization receives the best value.
Innovation and Continuous Learning:
- Stay informed about industry trends, emerging technologies, and regulatory changes affecting billing and enrollment operations.
- Drive innovation in the billing and enrollment space by exploring new technologies, such as AI, machine learning, and RPA (Robotic Process Automation).
- Encourage continuous learning and professional development within the IT team.
Qualifications:
Required:
- Bachelor's degree in Information Technology, Computer Science, or a related field.
- 8-10 years of IT experience, with at least 5 years in a leadership role focused on healthcare, preferable within member billing and enrollment functions.
- Extensive experience in the healthcare payer industry, with a strong understanding of billing and enrollment processes.
- Proven track record of leading IT projects that drive process improvement and operational efficiency.
Skills:
- Strong leadership and team management skills, with the ability to lead cross-functional teams.
- In-depth knowledge of billing and enrollment systems, including integration with other healthcare payer systems.
- Strong technical understanding of integration technology concepts.
- Excellent analytical and problem-solving skills, with a focus on process optimization.
- Experience with healthcare regulatory compliance, particularly in areas related to data security and member information.
- Excellent vendor management skills.
- Strong communication skills, with the ability to interact effectively with both technical and non-technical stakeholders.
This position is a Hub role, which requires an employee to occasionally come onsite to the Minnetonka office for applicable heads-up work. Frequency is determined by business need as decided by leadership.
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