A fantastic career opportunity for VP of Independent Physician Association IPA Claim Operations is now available to work remotely with a reputable Healthcare organization in beautiful warm and coastal California. If you enjoy a fun lifestyle in a moderate climate with many choices of outdoor activities, art scenes, wineries and great food, look no further!

The VP of Independent Physician Association IPA Claim Operations will be part of an organization that provides extensive care services range from primary care and specialty physician services to acute care hospitals and skilled nursing facilities to behavioral health and wellness services. Each of the Independent Physician Associations (IPAs) and networks supports the use of advanced diagnostic and treatment tools to provide members with convenient access to state-of-the-art healthcare.

The VP of Independent Physician Association IPA Operations will be responsible for developing and leading the company’s operational policies, objectives, and initiatives to support ongoing national growth for all product lines (including Medicare, Medicaid, Commercial, and Exchange), risk models (value-based care, professional risk, global risk), and delegation levels.

The VP of Independent Physician Association IPA Claim Operations will create and execute strategies to attain short- and long-term financial and mission-critical operational goals, while ensuring compliance with federal, state, and health plan regulations/policies. Utilization of continuous process improvement techniques and technology solutions will be key to successfully delivering on quality and productivity goals.

The VP of Independent Physician Association IPA Claim Operations will provide leadership and direction for key operations departments including Claims Payment, System Configuration for contracts/benefits/DOFRs, Encounter Data, Customer Service, Credentialing, and Provider Data Management.  The VP of Independent Physician Association IPA Operations will ensure department staff goals are established and monitored to drive company goal achievement annually.

The VP of Independent Physician Association IPA Claim Operations will maintain working knowledge of healthcare regulations and health plan policies to ensure compliance for all lines of business (Medicare, Medicaid, Commercial, Exchange) and in all operating states. Monitors regulatory and health plan audit results to identify and address any adverse trends. In addition, establishes and monitors internal quality assurance audit processes as a part of continued operational improvements.

The ideal candidate for VP of Independent Physician Association IPA Claim Operations should have California IPA experience with Bachelor’s degree in Business Administration, and Healthcare Management but MBA preferred. The VP of Independent Physician Association IPA Claim Operations should have at least 10 years of industry-related experience including three years in upper management required with experience managing over 300,000 claims.