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Director Reconciliation Services-HW


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Job Details

JobId: 867615BR
JobTitle: Director Reconciliation Services-HW
State: AR
Description: Provides overall direction by analyzing business objectives and customer needs; developing, communicating, building support for, and implementing business strategies, plans, and practices; analyzing costs and forecasts and incorporating them into business plans; determining and supporting resource requirements; evaluating operational processes; measuring outcomes to ensure desired results; identifying and capitalizing on improvement opportunities; promoting a customer environment; and demonstrating adaptability and sponsoring continuous learning. Develops and implements strategies to attract and maintain a highly skilled and engaged workforce by diagnosing capability gaps; recruiting, selecting, and developing talent; supporting mentorship, workforce development, and succession planning; and leveraging the capabilities of new and existing talent. Cultivates an environment where associates respect and adhere to company standards of integrity and ethics by integrating these values into all programs and practices; developing consequences for violations or non-compliance; and supporting the Open Door Policy. Develops and leverages internal and external partnerships and networks to maximize the achievement of business goals by sponsoring and leading key community outreach and involvement initiatives; engaging key stakeholders in the development, execution, and evaluation of appropriate business plans and initiatives; and supporting associate efforts in these areas. Evaluates the returns and risks of Health and Wellness business choices by analyzing objective financial and business data; analyzing current outcomes to identify and communicate areas of opportunity to the billing teams or improve operational or systematic processes; analyzing trends and patterns to determine root causes; overseeing the development of plans to increase profitability; collaborating with contracting teams, third-party vendors, and financial services to minimize financial loss; ensuring team identifies financial loss patterns and seeks resolutions; determining needed process changes and validating new process improvement; working on cross-functional teams to operationalize reporting requirements; evaluating operational processes; and measuring outcomes to ensure desired results. Directs all functions of the reconciliation and contract management processes from concept to implementation by ensuring contractual obligations are met; applying cross-functional knowledge and resources to produce results to support the company strategy; collaborating and communicating with key stakeholders to determine process gaps; communicating where inefficiencies occur; utilizing internal and external resources to apply successful business solutions; presenting immediate and future business projections, results, risks, and needs to senior leadership; determining needed process changes, seeking resolution, and validating new process improvements; developing models to facilitate and ensure proper controls and plan profitability; developing new Maximum Allowable Cost (MAC) Pricing review; evaluating the financial reconciliation on our pharmacy contracts; utilizing models and analysis to negotiate contract terms; managing the development of all reconciliation and plan profitability reporting; and negotiating recoupment. Oversees risk mitigation for financial reporting by ensuring division adherence to and compliance with company and legal standards (for example, Sarbanes-Oxley); collaborating with Health and Wellness controller to ensure accuracy of accounts receivable; ensuring cash application rules and business processes; overseeing government payment compliance; managing audit of third-party sales reporting; determining possible areas of risk; and developing risk mitigation plans. Serves as the contract reconciliation subject matter expert and senior advisor to the contracting group by directing and recommending reconciliation contract terms, profitability, and reimbursements
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