Longevity Health Plan is growing and looking to hire a Director of Business Services Data Integrity.
Longevity Health Plan continues to experience rapid growth and is looking to add new talent to our team. Longevity Health Plan currently has operations in Colorado, Florida, Illinois, Michigan, New Jersey, New York, and North Carolina, with plans to start up operations in additional states in the very near future. Due to our rapid growth, we have an immediate need for a Director of Business Services Data Integrity.
Longevity Health Plan is a Medicare Advantage Institutional Special Needs Health Plan (ISNP) for long-term nursing home residents. Longevity Health Plan covers all medically necessary and preventive services covered under Medicare Part A (Hospitalization) and Part B (Medical), and Part D (Prescription Drug). We’re focused on improving our members’ physical, mental, and social well-being through personalized clinical care and therapies.
General Purpose: The individual holding this position is required to support and demonstrate their commitment to the Longevity Health Plan (LHP) Statement of Purpose, which is: To improve the health and quality of life of nursing home residents by caring for their unique medical, social, and emotional needs.
The Director of Business Services Data Integrity is responsible for ensuring data integrity across all operational areas of LHP such as membership enrollment, pharmacy processes, provider directories, clinical care management, website, and claims operations.
This role will define strategies and controls, to validate data received from third parties prior to it being ingested into LHP’s core EMR platform, data warehouses, and migrating into any reports generated from source systems.
This role will oversee data exchanges with partners (such as SNFs) so that accurate data is timely submitted to partners (including regulatory bodies) as well as ingested on an efficient and automated basis.
The Director of Business Services Data Integrity will lead the continual improvement of operational processes through automation, optimization, and management.
The Director of Business Services Data Integrity will constantly leverage appropriate technology to improve the quality, enhancing effectiveness while minimizing data-processing costs, resources consumed, and time for LHP.
This role will assure adequate controls are in place to continually maintain data consistency and accuracy.
The Director of Business Services Data Integrity will provide strategic leadership and development of the Operations Department and its employees, as well as collaborate with IT, Network Development, Clinical Care Management, and third parties such as Third Party Administrators, Pharmacy Benefit Managers who handle functions such as member relations, claims processing and benefits administration to ensure data integrity and to drive financial and operational value across LHP to maximize benefit coverage while containing cost.
This role through inter-professional collaboration will ensure that TPA and LHP are notified in a timely fashion of any changes in process or procedures which would impact their functions.
The Director of Business Services Data Integrity will support regulatory queries and requests for data including “universe” production.
Key Tasks and Responsibilities:
Lead, manage and efficiently deliver the above services addressing the LHP data needs for efficient and comprehensive ingestion while storing data in an organized fashion to facilitate analytics and reporting. This role will lead the interaction of data flows with (Membership, Claims, Member relations, data sharing (to and from partners) flow – intake/ingestion team, & Claims/Billing) with a member-first and metrics-driven approach.
Set and deliver on LHP Operations strategy by delivering on the above data intake, maintenance, organization, rationalization, and sharing, quarter over the quarter across all sectors, in support of company objectives.
Work cross-functionally and strategically with Finance, Analytics, Business Development, Business Operations, Clinical Care Management Operations, Third Party Administrators, Data Science, and the Executive Team to achieve shared success and impact from smooth exchanges of meaningful data.
Relentlessly optimize LHP Operations in service of member experience, best-in-class revenue cycle management, and key business objectives.
Continue to build LHP Operations into a strategic asset in collaboration with our third parties and technology team.
Performs other related duties as assigned.
Education and Training:
Bachelor’s degree in Healthcare Administration (or other related areas) with a master’s degree preferred.
Formal training in Operations Management, Six Sigma, or Quality Improvement is a plus.
Knowledge and Experience:
10+ years of experience in operations, health plan administration, and strategy with a proven ability to oversee successful operations management at or above $10M annually.
5+ years of cross-functional leadership and management experience at the Director level in high-growth and/or healthcare systems.
Excellent understanding of data integrity and efficiency challenges in a health plan in areas such as membership enrollment, CMS reporting, and claims processing.
Preferred direct healthcare experience working with payers, providers, and health systems.
Consistent top performer, yet a collaborative and cross-functional leader who thrives in a culture of collaboration, accountability, and entrepreneurship.
A self-starter with proven ability and desire to build effective internal and external relationships with third-party vendors.
Exceptional at communication both written, verbal, and listening skills.
Company policy requires that all employees be vaccinated for COVID-19. The Company will engage in an interactive process with individuals who cannot be vaccinated for medical or sincerely held religious beliefs to determine if a reasonable accommodation can be made. While an exemption/accommodation may be initially granted, if at any time during employment, it is determined that an exemption/accommodation that has been granted is no longer considered a reasonable accommodation, it can result in the exemption/accommodation being revisited.
Candidates must meet the Company’s hiring criteria which include a pre-employment background and drug screening.
Longevity Health Plan is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, gender, national origin, disability status, protected veteran status, or any other characteristic protected by law.
Longevity Health Plan offers competitive compensation and benefits package which includes medical, dental, vision, short and long-term disability, life insurance, and 401(k).
Submission of false information during the application process may result in immediate termination of employment without notice.
Longevity Health Plan is a Medicare Advantage Institutional Special Needs Health Plan (ISNP) specifically available for long term nursing home residents. Longevity Health Plan covers all medically necessary and preventive services covered under Medicare Part A (Hospitalization) and Part B (Medical), and Part D (Prescription Drug). We’re focused on improving our members’ physical, mental, and social well-being through personalized clinical care and therapies.
The Longevity Health Plan Statement of Purpose is: To improve the health and quality of life of nursing home residents by caring for their unique medical, social and emotional needs.