Senior Director - Encounters Technology Operations

It’s an exciting time to join the WellSense Health Plan, a growing regional health insurance company with a 25-year history of providing health insurance that works for our members, no matter their circumstances.

Job Summary:

The Senior Director - Encounters Technology Operations will lead all aspects of the delivery and support for submission of Encounters to MassHealth and New Hampshire DHHS. The Senior Director is accountable for ensuring compliance with contracted service levels for timeliness and accuracy of Encounter submissions. The Senior Director will oversee the creation and implementation of the end-to-end Encounters submission processes and manage the resources charged with the implementation and management of those processes. The Senior Director will partner and collaborate with the Business Encounters Operations Team, Information Technology, Finance, Compliance, and other departments to coordinate Encounters submissions, resolve issues, and respond to audits in a timely manner.

Our Investment in You:

·       Full-time remote work

·       Competitive salaries

·       Excellent benefits

Key Responsibilities:

Strategic Leadership: In collaboration with Senior Leadership, establish and drive WellSense’s technology and operational strategy for delivery of Encounters submissions to MassHealth and New Hampshire DHHS. This includes establishing quality protocols, documentation, and processes for ongoing submission.

Management: Lead and manage the IT Encounters Operations Team of data and operations analysts charged with the timely and accurate submission of Encounters.

Budget and Cost Estimation: Work with the Vice President of Cloud Data Platform to determine estimated costs of IT Encounters Operations and vendor costs associated with operations. Track actual spend against budget and document reasons for variance.

Data Privacy and Security: Ensure that Encounters data is compliant with applicable HIPAA and other WellSense policies for data privacy and security.

Compliance: Ensure that Encounters submissions comply with federal and state service levels for timeliness and quality. Collaborate with WellSense Compliance and other departments to respond to audits and other requests on-time.

Continuous Improvement: Ensure the establishment and management the end-to-end processes for Encounters data management from source to final Encounter resolution.

Vendor Relationships: Partner with strategic vendors in the implementation of Encounters processes. Manage budgets, contractual agreements, and support for critical initiatives.

Problem Solving: Create and manage the Encounters issue resolution process that includes the documentation of the receipt/acknowledgement of issues, root-cause analysis, and the creation of plans to resolve issues within the timeframes established by the states.

Quality: Establish and monitor quality metrics for Encounters Management and review with Senior Management on a regular basis.

Collaboration: Work across internal and external groups to communicate Encounters priorities and work with management across teams to ensure adequate staffing is available to address issues and implement new initiatives, respond to audit requests, and support internal/external reporting needs

Regulatory Knowledge: Monitor state and state related agency guidelines on submission requirements and rules for Encounter submissions. Ensure stakeholders are aware of any changes and create plans to meet changing requirements within the timeframes specified by the states.

Competencies, Skills, and Attributes:

·       Demonstrated success in leading Encounters Operational teams for similarly sized organizations.

·       Effective communicator who can synthesize complex issues into simple language to accurately communicate to colleagues, Senior Management and representatives from Mass Health and New Hampshire DHHS.

·       Experience in managing Corrective Action Plans issued by regulatory bodies. This includes documenting root cause analyses and creating executing on the plans.

·       Working knowledge of HIPAA and PHI data handling standards.

·       Thorough understanding of the claims lifecycle and the Encounters submission lifecycle.

·       Strong project/program management skills and ability to hold accountable individuals who may not be in the person’s line of supervision.

·       Strong understanding of data warehousing technology and design.

·       Willingness to get hands-on in the execution of the team’s work including the ability to use tools such as Jira and Confluence to organize initiatives into stories and sprints and to lead daily stand-up meetings to ensure on-time delivery of projects. Use Confluence to document Encounters processes, tools, etc.

·       Detail oriented, excellent proof reading and editing skills

Minimum Qualifications:

·       Bachelor's or master’s degree, or equivalent experience, in computer science, Engineering, or a related field.

·       10+ years of managing data and operational analysts

·       7+ years of leading encounters operations functions for a healthcare plan.

Working Conditions and Physical Effort:

·       Fast-paced office environment

·       Occasional travel may be required.

·       Work is normally performed in a typical interior/office work environment.

Compensation Range 

$150,500 - $218,500

This range offers an estimate based on the minimum job qualifications.  However, our approach to determining base pay is comprehensive, and a broad range of factors is considered when making an offer.  This includes education, experience, skills, and certifications/licensure as they directly relate to position requirements; as well as business/organizational needs, internal equity, and market-competitiveness. In addition, WellSense offers generous total compensation that includes, but is not limited to, benefits (medical, dental, vision, pharmacy), merit increases, Flexible Spending Accounts, 403(b) savings matches, paid time off, career advancement opportunities, and resources to support employee and family wellbeing.  

Note: This range is based on Boston-area data, and is subject to modification based on geographic location. 

About WellSense

WellSense Health Plan is a nonprofit health insurance company serving more than 740,000 members across Massachusetts and New Hampshire through Medicare, Individual and Family, and Medicaid plans. Founded in 1997, WellSense provides high-quality health plans and services that work for our members, no matter their circumstances. WellSense is committed to the diversity and inclusion of staff and their members.

Qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, sexual orientation, gender identity, disability or protected veteran status. WellSense participates in the E-Verify program to electronically verify the employment eligibility of newly hired employees