Senior Director - Encounters Technology Operations

It’s an exciting time to join the Well Sense Health Plan, a growing regional health insurance company with a 25-year history of providing health insurance that works for our members, no matter their circumstances.

The Senior Director - Encounters Technology Operations will lead all aspects of the delivery and support for submission of Encounters to Mass Health and New Hampshire DHHS. The Senior Director is accountable for ensuring compliance with contracted service levels for timeliness and accuracy of Encounter submissions. The Senior Director will oversee the creation and implementation of the end-to-end Encounters submission processes and manage the resources charged with the implementation and management of those processes.

The Senior Director will partner and collaborate with the Business Encounters Operations Team, Information Technology, Finance, Compliance, and other departments to coordinate Encounters submissions, resolve issues, and respond to audits in a timely manner.

• Full-time remote work
• Competitive salaries
• Excellent benefits

• Strategic Leadership: In collaboration with Senior Leadership, establish and drive Well Sense’s technology and operational strategy for delivery of Encounters submissions to Mass Health and New Hampshire DHHS. This includes establishing quality protocols, documentation, and processes for ongoing submission.
• Management: Lead and manage the IT Encounters Operations Team of data and operations analysts charged with the timely and accurate submission of Encounters.
• Budget and Cost Estimation: Work with the Vice President of Cloud Data Platform to determine estimated costs of IT Encounters Operations and vendor costs associated with operations. Track actual spend against budget and document reasons for variance.
• Data Privacy and Security: Ensure that Encounters data is compliant with applicable HIPAA and other Well Sense policies for data privacy and security.
• Compliance: Ensure that Encounters submissions comply with federal and state service levels for timeliness and quality. Collaborate with Well Sense Compliance and other departments to respond to audits and other requests on-time.
• Continuous Improvement: Ensure the establishment and management the end-to-end processes for Encounters data management from source to final Encounter resolution.
• Vendor Relationships: Partner with strategic vendors in the implementation of Encounters processes. Manage budgets, contractual agreements, and support for critical initiatives.
• Problem Solving: Create and manage the Encounters issue resolution process that includes the documentation of the receipt/acknowledgement of issues, root-cause analysis, and the creation of plans to resolve issues within the time frames established by the states.
• Quality: Establish and monitor quality metrics for Encounters Management and review with Senior Management on a regular basis.
• Collaboration: Work across internal and external groups to communicate Encounters priorities and work with management across teams to ensure adequate staffing is available to address issues and implement new initiatives, respond to audit requests, and support internal/external reporting needs.
• Regulatory Knowledge: Monitor state and state related agency guidelines on submission requirements and rules for Encounter submissions. Ensure stakeholders are aware of any changes and create plans to meet changing requirements within the time frames specified by the states.

• Demonstrated success in leading Encounters Operational teams for similarly sized organizations.
• Effective communicator who can synthesize complex issues into simple language to accurately communicate to colleagues,…