Meridian Health Plan Director of MeridianCare Operations in Detroit, Michigan

Overview:

Who we are:

Meridian Health Plan is a family-owned, family-operated company of passionate leaders, achievers, and innovators dedicated to making a difference in the lives of our members, our providers and in the healthcare industry.

We provide government-based health plans (Medicare, Medicaid, and the Health Insurance Marketplace) in five different states (Michigan, Illinois, Indiana, Kentucky, and Ohio).

Our employees work hard, play hard, and give back. Meridian employees enjoy: Happy hours, special events, company sports teams, potlucks, Bagel Fridays, weekly Executive Lunches, and volunteer opportunities.

A Day in the Life of a Director of MeridianCare Operations:

This position is responsible for utilizing discipline, analyses and expertise to influence, lead and educate people and groups within the organization and, as necessary, outside of Meridian Health Plan, to optimize the results of MeridianCare Operations. This position is also responsible for Claims, Enrollment, Vendor Management, Grievances & Appeals and Member Services. At all times, this position must conduct themselves in a professional and fully compliant manner with all state and federal regulatory requirements.

Responsibilities:

  • Develops strategic and tactical marketing plans based on business strategy and plans

  • Develop and manage to annual MeridianCare Budgets across all states and markets.

  • Proactively builds effective, strategic working relationships with product, communications, sales and regulatory leaders throughout Meridian.

  • Develop and manage the MeridianCare claims department to achieve 85% or higher auto adjudication rate for payment with a 98.5% accurate rate.

  • Develop and Manage the Grievances and Appeals department to ensure compliance with required ODAG turnaround times for notification and resolution.

  • Maintain and Manage vendor relationship ranging from globally capitated arrangement to dental vendors.

  • Develops a strong working relationship with the corporate compliance team as well as the Meridian CMS plan manager(s).

  • Works with Regulatory and Compliance Department to ensure all business activities are compliant with federal and state regulators

  • Oversees/manages the enrollment and disenrollment interactions internally and externally to CMS (including but not limited to paper enrollment processing, OEC processing and DTC processing)

  • Coordinates internal resources in preparation for all internal and external operational Medicare audits.

  • Identifies and enlists the cooperation of individuals, groups, social service agencies and other community organizations in educational and outreach activities.

  • Supports health and wellness education activities; referral of members to health education programs.

  • Identifies cultural issues regarding current and potential members; communicates those issues and concerns to management immediately.

  • Maintain disenrollment rate that is deemed acceptable from the company

  • Strictly adhere to all CMS and Meridian Marketing MIPPA regulations.

  • Traveling to other territories

Qualifications:

What you can bring to Meridian:

  • Bachelor’s Degree or Fellow Designation from the Academy of Healthcare Management (AHM) is required;

  • Meridian Medicare Sales Certification and Recertification (as appropriate)

  • Five years operations

  • Two years Training experience

  • Five years Medicare experience

  • Ten years of expanding leadership/managerial experience

What Meridian can offer you:

  • Our healthcare benefitsinclude a variety of PPO plans that are effective on the first day of employment for our new full-time team members.

  • Opportunity to work with theindustry’s leading technologiesand participate in unique projects, demonstrations, conferences, and exclusive learning opportunities.

  • Meridian offers401k matchingthat is above the national average.

  • Full-time MHP employees are eligible for tuition reimbursementtowards Bachelor’s or Master’s degrees.

  • Meridian Health Plan was named Detroit's #1 Fastest Growing Companyby Crain's Magazine, so it is a great time to get involved with Meridian.

Job ID 2017-4649

Job Location US-MI-Detroit

Category Medicare Operations

Business Line CMC Corporate