Johns Hopkins Medicine Director of Operations, Claims in Glen Burnie, Maryland

Director of Operations, Claims

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Johns Hopkins Health Care,
Glen Burnie, MD
Requisition # 156061
Day Shift
Full Time (40 hours)
Weekend Work Not Required

Johns Hopkins employs more than 20,000 people annually across our health system. Upon joining Johns Hopkins, you become part of a diverse organization dedicated to its patients, their families, and the community we serve, as well as to our employees. Career opportunities are available in academic and community hospital settings, home care services, physician practices, international affiliate locations and in the health insurance industry. If you share in our vision, mission and values and also have exceptional customer service and technical skills, we invite you to join an employer that is a leader and innovator in the healthcare field.

Position Summary : Formulates strategic plans for effective claim processing and service, directs the Coordination of Benefits (COB) department to accurately allocate monies paid or potentially paid, and oversees audit and recoupment procedures to recover or avoid overpayments in order to ensure a reduction in care costs for JHHC. Responsible for corporate direction and oversight of COB and claims cost management charges.

Competencies :

A. Education:

BA/BS in Business Administration, Accounting, Finance, Information Systems or equivalent. MBA or CPA is preferred.

B. Knowledge:

Thorough knowledge of COB rules and laws including NAIC guidelines and MSP requirements. Thorough understanding of JHHC claims and service system and conversant in PC environment.

C. Skills:

Excellent verbal and written communication skills and the ability to negotiate with all levels internally and externally. Problem solving and analytical skills are essential in order to develop and execute strategic and tactical business plans. The ability to manage multiple projects and motivate others in a dynamic environment.

D. Required Licensure, Certification, Etc.:

NA

E. Work Experience:

8 years or more of progressive management experience in internal auditing, corporate accounting, strategic planning, insurance industry business operations, health care industry operations.

Johns Hopkins Health System and its affiliates are Equal Opportunity/Affirmative Action employers. All qualified applicants will receive consideration for employment without regard to race, color, religion, sexual orientation, gender identity,sex, age, national origin, disability, protected veteran status, and or any other status protected by federal, state, or local law.