Top 21 Senior director Jobs in Falmouth, Me

Senior Director, Claims & Payment Integrity - Remote
Martin's Point Health Care —Portland, ME
- $165,546.85 - $204,499.05 a year
- Full-time
- Remote
- Inventory management
- Research
- Master's degree
- Health insurance
- Dental insurance
Medical Director/ Attending Physician
MedElite Group, LLC. —Portland, ME
- $200,000 - $300,000 a year
- Full-time
- Skilled nursing facility
- Geriatrics
- Senior level
- Dental insurance
- 401(k)
Quick Apply
Director-Sr Rehab (Sr. DOR)
Powerback Rehabilitation —Westbrook, ME
- $40 - $50 an hour
- Full-time
- Physical & Rehabilitation Medicine
- Bachelor's degree
- Children
- Relocation assistance
- Health insurance
Senior Director - Engineering
MaineHealth —Portland, ME
- $142,792.00 - $193,211.20 a year
- Email
- Carpentry
- Engineering
- Plumbing
- Paid parental leave
- Parental leave
Senior Director of Commercial Enablement
IDEXX —Westbrook, ME
- From $240,000 a year
- Full-time
- Office
- Analysis skills
- Bachelor's degree
- Health insurance
- Dental insurance
Senior Director of Analytics & Operations
University of New England —Biddeford, ME
- Online Application
- 3 years
- SQL
- Analysis skills
- Health insurance
- Dental insurance
Sales Director/Director of Community Relations
Benchmark Senior Living —Yarmouth, ME
- $75,000 a year
- Weekends as needed
- Microsoft Excel
- Microsoft Outlook
- Research
- Disability insurance
- Health insurance
Quick Apply
8d
Senior Director - Quality and Safety - MaineHealth Behavioral Health
MaineHealth —Westbrook, ME
- $122,408.00 - $165,630.40 a year
- Email
- 5 years
- Master's degree
- Math
- Paid parental leave
- Parental leave
Activity Director
Benchmark Senior Living —Yarmouth, ME
- $66,000 a year
- Full-time
- Experience working with individuals with disabilities
- Mid-level
- Bachelor's degree
- Disability insurance
- Health insurance
Quick Apply
5d
Branch Director, Home Health
Centerwell —Portland, ME
- $93,000 - $128,000 a year
- Full-time
- Microsoft Word
- Nursing
- Microsoft Excel
- Paid parental leave
- Paid holidays
Associate Medical Director, Palliative Care
MaineHealth —Scarborough, ME
- $268,975 a year
- Email
- Medicine
- BC/BE
- Inpatient
- Relocation assistance
- Vision insurance
Residential Care Director
Clover Healthcare —Auburn, ME
- $100,000 - $112,000 a year
- Full-time
- Hospitality
- Clean driving record
- LVN
- Wellness program
- Continuing education credits
Quick Apply
Senior Director Engineering, Home Software Applications
Generac Power Systems Inc —South Portland, ME
- $239,000 - $323,000 a year
- Full-time
- Computer Science
- Bachelor of Science
- System design
- Health savings account
- Paid holidays
Quick Apply
Head of Satellite Telemetry (TT&C)
Holt Executive —United States
- Master's degree
- Analysis skills
- Telemetry
Quick Apply
13d

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Senior Director, Claims & Payment Integrity - Remote

Martin's Point Health Care -
Portland, ME

Apply Now

Job Details

Full-time
$165,546.85 - $204,499.05 a year

Benefits

Health insurance
Dental insurance
Paid time off
Vision insurance
Volunteer time off

Qualifications

Vendor relationship building
Employee relationship building
Research
Bachelor's degree
Data-driven problem-solving

Full Job Description

Join Martin's Point Health Care - an innovative, not-for-profit health care organization offering care and coverage to the people of Maine and beyond. As a joined force of "people caring for people," Martin's Point employees are on a mission to transform our health care system while creating a healthier community. Martin's Point employees enjoy an organizational culture of trust and respect, where our values - taking care of ourselves and others, continuous learning, helping each other, and having fun - are brought to life every day. Join us and find out for yourself why Martin's Point has been certified as a "Great Place to Work" since 2015.

Position Summary

The Senior Director, Claims & Payment Integrity, is responsible for oversight of health plan claims administration and payment integrity functions. The position will develop, maintain, and optimize process flows to maintain claims payment accuracy.

Job Description

Key Outcomes:

Drives quality, timely claims processing to allow the health plan to achieve regulatory compliance, robust financial management and product strategy outcomes
Oversee strong inventory management processes and enhance auto adjudication
Delivers strong vendor oversight to optimize system processing to improve efficiency and accuracy; pursue new vendor opportunities including Request for Information (RFI)/Request for Proposal (RFP) as deemed appropriate
Collaborates with business and IT teams to ensure system and operational readiness for system fixes, configuration, and project rollouts impacting claims processing
Ensures operational readiness, testing, training, reporting, and communications are in place for claims processing updates
Acts as business owner for claims processing and edit vendors, ensuring oversight of vendor, including day-to-day management, roadmap reviews and joint operating committee management
Oversees, develops, and maintains documentation for claims and configuration processes and procedures with appropriate controls, reporting and quality assurance
Develops work intake mechanisms, exploring and implementing tools to manage claims processing tickets, prioritize backlog and assess different work types (i.e., reporting, configuration, project vs. production fixes, etc.)
Remains up to date on industry trends and advancements in claims provider reimbursement and system technology to identify opportunities for improvement
Supports regular audits and quality checks to ensure data accuracy and system performance
Oversees the research, development, implementation, ongoing operational maintenance and administration of provider payment methodologies and fee schedules for all provider types in support of provider contractual arrangements
Supports the development and integration of provider payment policies and guidelines applicable to institutional and professional reimbursements and in concert with the Organization's products and member benefits
Maintains all institutional and professional reimbursement methodologies leveraged by the organization. This includes demonstrating deep knowledge in industry standard payment methods
Demonstrates working knowledge in the design and roll out of alternative payment methods that are focused on an incentive-based pay for value approach. This will require partnering cross organizationally to support the development of these new programs, and direct the operational activities necessary to stand them up
Researches and provides recommendations on development of new or enhancements to existing reimbursements in conjunction with corporate and contractual initiatives including sound financial modeling/impact analyses

Education/Experience:

Bachelor’s degree required; Master’s in business administration or comparable advanced degree strongly preferred
CPC Preferred
10+ years health plan management experience required
Experience managing vended system applications
Experience with test plan development, strategy, and execution

Skills/Knowledge/Competencies (Behaviors):

Demonstrates an understanding of and alignment with Martin’s Point Values.
Maintains knowledge and understanding of reimbursement agreements as well as claims and billing practices that impact cost and utilization data.
Detailed knowledge of applicable regulatory and accrediting body standards (National Committee of Quality Assurance (NCQA), Centers of Medicare and Medicaid Services (CMS))
Develops and maintains positive, effective working relationships with colleagues, vendors, and other internal and external customers.
Excellent workflow and inventory management skills.
Excellent problem solving, quantitative and analytical skills with the ability to assess performance against metrics.
In-depth technical knowledge and ability to learn new technologies; knowledge of the Software Development Life Cycle (SDLC).
Ability to manage, organize, and prioritize workload in a timely accurate manner.
Ability to manage multiple competing demands and function independently.
Knowledge of industry standards for claims and enrollment configuration, reporting and analysis.
Knowledge of benefit coverage and servicing members, providers, and the DoD, CMS/ Medicare Advantage, and ME state insurance coverage.
Knowledge of managed care computer systems, features, and reporting.
Demonstrated interpersonal, communications, operational, team building, and quality improvement skills.
Critical thinking: can identify root causes and implement short- and long-term sustainable solutions.

There are additional competencies linked to individual contributor, provider, and leadership roles. Please consult with your leader to discuss additional competencies that are relevant to your position.

Pay Range: $165,546.85 - $204,499.05 The pay range above reflects the anticipated base pay range based on a full-time position. Actual compensation will be determined based on factors such as experience, skills, qualifications, and other job-related considerations. Employees may also be eligible for additional compensation, including incentive or commission-based programs, where applicable and subject to the terms of the relevant plan. In addition to base compensation, we offer a comprehensive benefits package including medical, dental, vision, retirement savings with employer contributions, paid time off (including volunteer time off!), pie day, and other employee benefits.

This position is not eligible for immigration sponsorship.

We are an equal opportunity/affirmative action employer.

Martin's Point complies with federal and state disability laws and makes reasonable accommodations for applicants and employees with disabilities. If a reasonable accommodation is needed to participate in the job application or interview process, to perform essential job functions, and/or to receive other benefits and privileges of employment, please contact [email protected]

Do you have a question about careers at Martin’s Point Health Care? Contact us at: [email protected]

Apply Now

Refine Your Search

senior director jobs in falmouth, me

Senior Director, Claims & Payment Integrity - Remote

Medical Director/ Attending Physician

Director-Sr Rehab (Sr. DOR)

Senior Director - Engineering

Senior Director of Commercial Enablement

Senior Director of Analytics & Operations

Sales Director/Director of Community Relations

Senior Director - Quality and Safety - MaineHealth Behavioral Health

Activity Director

Branch Director, Home Health

Associate Medical Director, Palliative Care

Residential Care Director

Senior Director Engineering, Home Software Applications

Head of Satellite Telemetry (TT&C)

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I want to receive the latest job alert for senior director in falmouth, me

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Position Summary

Job Description

This position is not eligible for immigration sponsorship.

We are an equal opportunity/affirmative action employer.

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